ROOT END FILLING MATERIALS

Introduction: The purpose of root end filling is to establish a tight and biocompatible apical seal between the radicular space and the periapical tissues. Ideal Properties: Ideal properties for root end filing materials as proposed by Dr. L.I. Grossman are, 1. Should be well tolerated by periapical tissues 2. Should adhere to the tooth structure 3. Should be dimensionally stable 4. Should be resistant to dissolution 5. Should promote cementogenesis 6. Should be bactericidal or bacteriostatic 7. Should be non-corrosive 8. Should be electrochemically inactive 9. Should not stain tooth or periradicuar tissue 10. Should be readily available and easy to handle 11. Should allow adequate working time, then set quickly 12. Should be radiopaque

1

Recommended Materials: The suggested root-end filling materials till date include, 1. Gutta percha 2. Silver cones 3. Amalgam 4. Zinc oxide eugenol 5. Cavit 6. Polycarboxylate 7. Composite 8. Zinc phosphate 9. Gold foil 10. Glass ionomer cement 11. Lead points 12. Gold scres 13. Ward’s wonderpack cement 14. Poly hema 15. Tin foil 16. Ivory and plastics 17. Powdered dentin mixed with sulfathiazoles 18. Rickert’s root canal sealer 19. Titanium posts and screws 20. Silver post 21. Tin post 22. Aluminium oxide ceramic posts 23. Resorcine-formalin resin 24. Diaket 2

25. Biobond and EDH adhesive 26. Metallic retentive pins 27. Bone cements 28. MTA 29. Calcium hydroxide 30. Compomer 31. Hydroxyapatite cements

1. Gutta Percha: Either cold or warm gutta-percha can be used as a root end filling material. The cold gutta-percha can be condensed apically or pulled through the apical foramen or can be manipulated at its apical marginal interface with the root dentin walls to enhance its adaptation and seal. This can be accomplished with the use of solvents, excavtors, scalpels, burs and burnishers – both hot and cold. The adaptation of gutta percha is dependent on a multitude of variables such as. a) Nature of Gutta-Percha Used: Gutta-percha should have high rigidity, flexibility and yield strength. In addition, it should also have high percentage elongation and low resilience. But for these properties it requires chemical proportions opposite to those found in gutta percha endodontic filling materials. Gutta percha has both elastic and viscous properties and therefore referred to as viscoelastic. The property manifests itself during use in the root canal. Gutta percha requires a large, sustained force of condensation over an adequate period of time to deform plastically. The more it deforms, the more it flows and adapt to the dentin wall, decreasing gaps in the gutta-percha dentin interface. b) Thoroughness of Condensation:

3

prior to removal of the excess material. c) Placement and Condensation of Gutta-percha: Earlier the pulling of gutta-percha through the resected root end had also been advocated to ensure maximum adaptation to the dentinal walls. Most authors have recommended coronal condensation of the gutta-percha into the apical third of the canal and through the foramen. which would also produce voids in the sealer gutta-percha interface which can be easily exposed during the resection technique. But this has been shown to result in voids in the gutta-percha dentin interface as the gutta-percha tends to retract from the walls creating significant gaps at the interface. d) Use of Solvents: Use of various solvents such as euclyptol. This approach would tend to ensure a better gutta percha sealer adaptation to the dentin walls.For years many practitioners are achieving a respectable degree of success even without the placement of a root end filling material but with proper obturation and resecting the root ends. Harrison and Todd showed that root end resection with a high speed rotary instrument did not adversely affect the sealing property of well condensed gutta-percha sealer obturation. The sealers used would produce a very poor seal against fluids. the effects of the resection on the seal had never been evaluated. 4 . However. Most of the canals were filled with single cone techniques as the concept of coronal flaring was non-existent. But it has been shown that the material loses its dimensional stability as the solvent is lost from the mixture. chloroform or rosin have been recommended to enhance adaptation of the gutta-percha at the apex with or without resection. Cunningham in 1975 demonstrated that single cone gutta percha fills exhibited tearing and puling away from the dentin margin during resection.

scalpels. compared the use of warm plastic instrument in a cutting or searing motion and a cold ball burnishes to adapt the gutta-percha at the resected root end. Blister-circular hole which was found after heat application and Pullaway – void probably caused by the instrument pulling the gutta-percha away from the dentin. 5 . Tanzilli et al. the quality of adaptation appears to be operator dependent. excavators. In their study 3 discrepancies in adaptation were identified under SEM evaluation. Blum in 1930 claimed that the resecting bur burnished the gutta-percha at the orifice. However.e) Type of instrument used for adaptation of gutta-percha: Various instruments such as burs. f) Temperature of instrument used to remove gutta-perha: For years the use of a warm to hot instrument was advocated to smooth or burnish the gutta-percha at the normal apex or at the resected root end. contour or adapt the over extended gutta-percha filling material to perfect the marginal interface. Ross in 1973 indicated gutta-percha drags due to bur rotation during root end resection. Average size of the discrepancy Pullaway – 104 µ Blister – 62 µ (width) and 109 µ (length) Cold burnishing – Largest 5.6 µ Cold gutta-percha appeared to have superior adaptation to both amalgam and gutta-percha fills subsequent to root-end resection only. The were defined as defect – constant spacing between the material and dentin. plastic filling instruments and burnishers have been recommended to remove. spoon.

Leakage studies have demonstrated that high temperature thermoplasticized guttapercha seals well and if not better than high copper amalgam. found that hot burnished gutta-percha yielded a significantly greater leakage pattern to a silver nitrate dye than did cold burnished gutta-percha. as 95% of the samples in their study demonstrated penetration of the bacterial products. c) therapeutic based. McDonald et al. b)non-eugenol based.Kaplan and associates demonstrated that cold gutta-percha yielded least dye penetration. King and co-workers demonstrated that cold-burnished gutta-percha with sealer had significantly less leakage over time than amalgam with varnish and GIC with silver. It will have a direct bearing on the seal of the root canal system subsequent to root end resection and on the periradicular healing at the resected root surface with or without a root end filling. The residual eugenol in the eugenol based sealers that remains after the sealer set can affect the sealer’s properties or the periradicular tissue response. 6 . although initial osseous regeneration was slightly slow. Periradicular healing adjacent to root end fills with thermoplaticized gutta-percha was not significantly different than that adjacent to amalgam. Commercial sealers are generally grouped as a) eugenol based. g) Root canal sealers: The root canal sealers used in conjunction with solid core obturating materials are intended to enhance the fluid-tight or hermetic seal throughout the root canal system. Kos and coworkers found that the gutta-percha whether heat sealed or cold burnished did not prevent leakage.

2. its setting time and quantity or surface area of the material in contact with the tissues. as the circular. Sommer’s in 1946 presented a technique for a root-end fill with a silver cone subsequent to reverse canal instrumentation. especially when a post-core crown was present. Therapeutic sealers contain materials such as iodoform. A special instrument was designed to exert pressure along the long axis of the 7 . there is significant contact of these sealers with the periradicular tissues which may result in extensive tissue destruction with or without root end filling. Subsequent to resection in root filled teeth with these sealers. The ability of the silver cones to seal the root canal system three-dimensionally has been justifiably challenged. all sealers can cause tissue inflammation and cellular damage. its physical properties. This problem is accentuated subsequent to angled root-end resection as large areas of sealer is visible between the cone and dentin wall. The severity of damage appears to be related to the nature of the material. tapered nature of the cone provides only a central core material which is surrounded by a sea of root canal sealer.Non-eugenol based sealers use solvents such as chloroform or eucalyptol which have demonstrated toxicity in the initial stages of sealer set. tapped to place with a chisel and cut off and smoothened or burnished to confirm to the resected root surface. There are various recommendations for the use of silver cones as the apical filling material at the time of periradicular surgery. The cone was inserted into the canal at the resected root end. Silver Cones: Silver cones have been used to obturate root canals since the early 1930’s. Initially. paraformaldehyde or trioxymethylene which are claimed to have therapeutic properties. Elkof recommended a similar approach.

Harrison and Todd demonstrated that resection of root ends of single rooted teeth obturated with single silver cones and sealer adversely affected the seal. 8 . corrosion of a metal-worked con looms a a major factor for continued periradicular tissue irritation and ultimate failure of resected silver cone cases. post. these techniques have not specifically recommended the placement of a root end fill subsequent to resection of a silver cone. removing any silver corrosion products from the root canal system and replacing the silver cone with a well condensed guttapercha and root canal sealer fill. followed by grinding or planning of the cone flush with the resected surface. Ideally. However. In addition to the strong potential for voids and leakage to exist between a resected silver cone and dentin wall. Pryor and Summers have recommended the pulling or tapping of a silver cone through the resected root end. 3. teeth containing silver cones and requiring surgery should be nonsurgically retreated. Amalgam: One of the first reports of placing a root-end amalgam filing subsequent to resection is attributed to Farrar. followed by a smoothing of the surface with a round bur. Although there are a number of studies suggesting the use of amalgam as a root end filling material. necessitating a root-end fill. Trice recommended a fissure bur to cut through previously placed silver cones. if possible prior to surgery. Maxmen.“Silverstift” during placement from the resected root end to the apical extent of the canal. there are many controversies for the same.

9 .The factors to be considered when amalgam is used as a root end filling material are.

Therefore. However. The presence of high levels of copper has increased resistance to marginal breakdown. once solid amalgam phases form. corrosion prone γ2-phase. Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg γ γ1 γ2 where γ – phase is the strongest phase γ1. corrosion prone phase and may be a site of crack initiation and marginal failure High copper alloys: Ag3Sn + Cu + Hg  Ag3Sn + Ag2Hg3 + Cu6Sn5 γ γ1 n The copper that replaces some of the silver in these alloys reacts to form coppertin compound. The greatest potential for Hg release occurs from unreacted Hg in freshly triturated alloy. Studies have shown that the use of a dentin adhesive prior to placing a high copper spherical alloy has shown promise in the elimination of marginal leakage. the potential for Hg release is significantly reduced.a) Type of amalgam: The chemical reaction in conventional alloys between mercury and other components is as follows. The release of Hg may have an effect on the periradicular tissues and ultimate healing.reasonably corrosion resistant and v2 – comparatively weak. Another aspect of amalgam is the potential for release of mercury from the set amalgam over time. 10 . the eta phase which eliminates or diminishes the weak. higher compressive strength and reduced dimensional changes. all unreacted Hg is consumed within 2 hrs of set.

although sealant durability is limited. Sarkar and Eyer have described this phenomenon of reduced marginal fracture as a function of the high electroactivity of the zinc component of the amalgam. zinc was detected in the surrounding bone in two zinc amalgam root-end fills and in one non-zinc amalgam root-end fill. The presence of zinc in amalgam might cause hygroscopic expansion of the material in the presence of moisture. In 1959.Further studies have suggested a reduction in Hg vapour release when a sealer is placed over the alloy. suggestive of zinc carbonate was detected after 22 months of 11 . which minimizes the major chemical reactions in the corrosion process. enhances marginal integrity and reduces marginal fracture. zinc alloy minimizes the amount of porosity. Then is the role f zinc in amalgam as a root end filling materials. and with little substantiative scientific basis. recommendations appeared advocating the useof non-zinc amalgam alloys for root-end filligns. Omnell resented a case which involved a female patient who had undergone root end resection of a maxillary lateral incisor. reduces corrosive tendencies. which might further lead to amalgam or root fracture and leakage. Of the 16 specimens analysed. Microradiographic and radiographic diffraction investigations revealed the substance to be a zinc carbonate precipitate. On the other hand. He found periradicular bone destruction and deposition of a radiopaque substance reappeared after a second resection procedure. They have also shown in vitro the formation of a zinc stannate passive film over the alloy. He has used silver amalgam as a root end filling material in a tooth which contained a metallic post used to support a metallic crown. which could have deposited as a result of an electrolytic process because of the presence of the metallic post. In 1982 Kimura used dogs to determine the dissolution of metallic elements and the incidence of a zinc carbonate precipitate from zinc and non-zinc root-end silver amalgam fillings and bone implants. No precipitate. Subsequent to this case report.

g) Cleanliness and seal of the root canal system coronal to the root-end fill h) Use of cavity varnish Studies have shown that the use of two coats of varnish to seal not only the walls of the root-end preparation but also the cut dentinal tubules at the root surface reduces microleakage to a certain extent. may compensate for further leakage. However. 12 . However. The conclusions that can be drawn from these studies are that roote-end amalgam fillings may be minimally adequate at first.in vivo amalgam implantation. evaluations using hydroxyl ions to detect leakage have shown that varnishes do not inhibit microleakage in conjunction with amalgam restoration over a 6 month period. b) Marginal Adaptation: Multiple technique have been advocated to determine the apical leakage or marginal adaptation of root end amalgam fillings. chemical analysis of non-zinc amalgams in a 1% NaCl solution demonstrated the presence of a tin hydroxide film. Their study indicated that varnish dissolution occurred around the 7 month and that the corrosion process in a complex dynamic interplay. but shrinkage on setting wil occur. which is more susceptible to corrosive action without the presence of zinc. The key factors which interact with the marginal discrepancies include the – a) Mean leakage observed and its alteration with time b) Standard leakage from the mean leakage observed c) Depth of the amalgam d) Amount of amalgam corrosion and expansion anticipated e) Manipulation of the alloy during preparation and placement f) Place of the alloy in the canal prior to resection versus its us as a root-end fill only.

unset zinc and non-zinc amalgam in the tibias of rats. In 1975 Flanders and coworkers placed implants of non-zinc amalgam and cavit in the subcutaneous tissue and adjacent to bone in rats. X-ray microprobe analysis showed that bone adjacent to the amalgam implants contained tin and surface irrespective of the presence of zinc. d) Material preparation and manipulation: 13 . Studies have shown that zinc amalgams have more lasting cytotoxicity compared to the non-zinc amalgam which have very little cytotoxicity at 24 hrs after mixing. in an in vitro study used varnish and a light cured fissure sealant to enhance the sealing capacity. They found that the surface of all the implants were covered with an organic film at the 3 week evaluation period and with bone at later intervals. indicating an outward migration of specific components of the amalgam.Negm. They found tht cavit produced more severe reactions than did amalgam. This may be reflective of ongoing corrosion and alteration in the amalgam in contact with tissue fluids. Ligett and coworkers implanted freshly mixed. c) Tissue compatibility: Compatibility studies have demonstrated that freshly mixed conventional silver amalgam is very cytotoxic due to the unreacted mercury with cytotoxicity decreasing rapidly as the material hardens. He found that varnish did not significantly enhance the sealing capacity of the root-end filling materials where the use of a light cured fissure sealant (Helioseal) showed promise as an adjunct to foraminal and root face sealing. Martin and associates implanted both zinc and non-zinc amalgam in the subdermal and supramuscular regions of a rat. They could not find any significant differences in tissue response with the zinc and non-zing amalgam at 30 days.

Manufactures instructions to be followed during trituration. Burnishing improves the marginal adaptation and seal. 4. followed by burnishing to render the surface smother. In 1919. 7. Lucas recommended root canal fillings with amalgam before root-end resection. Messing and Cook recommended the use of root canal fillings with amalgam prior to resection. In an attempt to minimize variations. surface smoothness and the nature of surface constituents. Hill. and the use of large condenser in a lateral fashion may be desirable because a small head condenser tends to force amalgam mass away from the areas of condensation. 6. less pressure is required to properly condense these alloys. However. degree of porosity. the use of mechanical condensers may be limited. marginal adaptation. The optimal structure for the amalgam margins can be obtained by overfilling and burnishing of the margins and removal of the excess by carving. 2. 3. thereby discouraging formulation of small corrosion cells on the surface.The preparation and manipulation of the amalgam alloy at the time of placement is crucial in determining amalgam strength. Herbert. Also. Specific instruments such as Messing gun. Hill 14 . Amalgams squeezed of their excess Hg have a decrease in their final strength.Hg ratio-to be followed Eames technique or Jorgensen and Saito. Alloy:. Carving will still be necessary after burnishing. mixes of amalgam heavier than two spills should be avoided. Burnishing as a one-step procedure may be optimally accomplished at 4 to 6 min after trituration. Amalgams are more closely adapted to the confines of the cavity during mechanical rather than hand condensation. 5. Alloys consisting of spherical or mostly spherical particles are more fluid under condensation pressures. Some key points to consider relative to alloys placed intraorally are as follows:1.

Zn. Amalgam scattered in the surgical site due to removal of a failing root-end amalgam. f) Tissue staining or argyria: The possibility of tissue staining subsequent to root-end resection and/or root-end amalgam fillings may be due to – 1. 4. Hg and Ag) into the surrounding media. 3. the abraded amalgam due to bur marks from resection may be more prone to corrosion. the remainder of the canal can be obturated with gutta-percha or left vacant for post space. exposing the apical amalgam. Metallic changes due to the generation of electric currents have been identified as increases in tarnishing. 2. Fractured or loosened amalgam root-end fillings. which has the potential to generate significant amounts of electrical currents. which can be polished or burnished to enhance the marginal seal and surface finish. Amalgam scattered in the surgical site during placement of the root-end filling. Once the apical portion is filed with 3 to 7 mm of amalgam. Galvonism 15 . Sn. If not smoothly polished. 5. root end resection is performed. e) Galvanic Currents: The placement of a root-end amalgam in a tooth which has a metallic post or crown restoration could create a galvanic couple. corrosion.endodontic amalgam carrier and Endogun have been developed to introduce the amalgam to the apical third of the roots or to conveniently place a root-end filling. Later. Chemical corrosion of the root-end amalgam or silver cones at the resected root surface. porosities and marginal breakdown with leaching in metallic ion (Cu.

4. Further. Create a smooth surface on the finish alloy. if used are. the cement tended to be absorbed over time because of its high water solubility.6. When used as a retrograde filling. Silver scattered in the surgical site during resection of roots containing silver cones. Varnish or dentin bonding agents must be used prior to alloy placement. 8. 3. Nicholls showed preference for zinc-oxide eugenol cement over amalgam. 7. although the bulk of the alloy must be thick enough to resist fracture and to obdurate the entire canal system at the resected root surface. In order to overcome some of these problems to original ZnO eugenol cements were modified as IRM whch is reinforced by the addition of 20% polymethacrylate by 16 . 2. Because of the hydrolysis. High copper alloys are preferred to the others. 5. Zinc-oxide Eugenol: In 1962. the free eugenol may have several undesirable effects. Based on this discussion certain guidelines for amalgam as a root-end fillign material. Zn hydroxide and Eugenol are formed. Prevent dispersion of alloy particles in the surgical site. Zinc alloys are the material of choice when moisture is controlled. carve and burnish the alloy using a minimal number of firm strokes directed to the alloy dentin interface. The eugenol will continue to be removed by leaching until all the Zn eugenolate is converted to Zn (OH). 1. Control of moisture in the surgical site is essential. Carefully condense. 7. Deterioration of silver containing root canal sealer (Rickert’s sealer). The original ZnO eugenol cements were weak and had a long setting time. The diameter of the fill should be as small as possible. burnish. 4. 6.

They found than IRM was significantly more antibacterial than amalgam and also that amalgam was more cytotoxic than IRM. To further improve IRM as a retrograde filing material. Chong and associates compared the cytotoxicity of a GIC. In a tissue tolerance study it was found that IRM elicited a mild to no inflammatory effect after 80 days. Their results indicated that fresh IRM cement exhibit the most 17 . In a retrospective study done by Schwartz et al. Kalzinol.5% Natural resin Liquid – EBA EugenolIRM: IRM was found to have a milder reaction than unmodified ZnO eugenol.weight to the powder and super EBA which was modified by the addition of ethoxybenzoic acid to alter the setting time and increase the strength of the mixture. In this. but was not statistically different from plain IRM. 10% to 20% hydroxyapatite was added because of its biocompatibility with bone. amalgam and IRM had the same clinical effectiveness when used as a root end filling material. Owadally and associates reported on an in-vitro antibacterial activity and ctotoxicity study comparing amalgam and IRM. IRM.5% 37. IRM was found to have a statistically significant higher success rate compared to amalgam. Super EBA and amalgam. Ex: Stailine super EBA – Powder – ZnO SiO2 60% 34% 6% 62. The only disadvantage with this was increased disintegration which may allow leakage of potential irritants after a certain time period. partial substitution of eugenol (liquid) was done with ortho-ethoxybenzoic acid and fused quartz or alumina are added to the powder. This had produced a better seal than amalgam. In a retrospective study done by Dorn and Gartner.

pronounced cytotoxicity of all materials. To overcome this Tamazawa et al. Super EBA is difficult to mix and handle. However. It yields a high compressive and tensional strength. 18 . When the rolled super EBA mixture loses its shine and the tip does not droop when picked up by a carrier. Tissue tolerance studies show that super EBA and eugenol cements produce similarly mild reactions. Super EBA is a difficult material to manipulate because the setting is short and is greatly affected by humidity. Studies have shown that burnishing super EBA without polishing provides a better seal. After placing the mix in the cavity it has to be either burnished or polished. Compared to IRM. low solubility and radiopaque. added a soluble fluoride – Potassium hexafluoroziroconate which reduced the solubility of EBA cement to half of that of ZnPO4 in the in vitro evaluation. Super Ethoxybenzoic Acid: Because of the addition of the above mentioned modifiers the solubility of the cement was increased. The liquid powder ratio is 1 : 4. GIC and hot burnished gutta-percha. Aged Kalzinol was the second most cytotoxic material with no significant difference being reported between Vitrebond. the mixture has the right consistency. additional powder has to be added. EBA is the strongest and least soluble of all ZnO eugenol formulations. Leakage studies demonstrated that Super EBA allowed significantly less leakage than amalgam and produces a tight seal compared with amalgam. The powder is mixed into the liquid slowly in small increments. Stailine super EBA has a neutral pH. When the mixture is thick but still shiny. EBA and amalgam.

Tissue toxicity studies have shown that cavit is toxic to subcutaneous tissue and bone. cavit-G has been shown to exhibit greater leakage than IRM or ZOE. calcium sulphate. They found that Super EBA exhibited the least amount of leakage of all the materials tested. Biocompatibility studies with cavit are in conflict. glycol acetate. triethanolamine and polyvinyl acetate. GIC and hot burnished gutta-percha. giving it a high linear expansion. It is soft when placed in the tooth and subsequently undergoes a hygroscopic set after permeation with water. zinc sulfate.Brower and coworkers showed good apical marginal adaptation and less leakage of Super EBA compared to amalgam. This property has been cited as a rational for its use as a root-end filling material. showing it to be both toxic and non-toxic. using 45Ca leakage. It is also available in forms without the red pigment such as cavit-G and cavit-W. heat-sealed and cold-burnished gutta-percha and apical root-end resection only. Cavit: It is a temporary filing material which contains zinc oxide. Zinc Polycarboxylate: 19 . Initial studies by Parris and coworkers showed that during temperature cycling. On the other hand. 6. Delivanis and Tabibi. The ability of cavit to seal cavities is controversial. 5. polyvinyl chloride acetate and a red pigment. cavit sealed against dye and bacterial penetration as well as amalgam. Beltes and associates examined the seal of super EBA and compared it with amalgam and varnish. when evaluating apical leakage patterns demonstrated that the cavit seal deteriorated and leaked more than amalgam over a 6 month period.

However. And the liquid is an aqueous solution of polyacrylic acid. In 1941. Powder consists of modified zinc oxide with fillers such as Magnesium oxide and Stannous floride.7. Apical leakage studies have indicated that polycarboxylates when used as rootend fillings.It is available as a powder-liquid system. the osseous tissue adjacent to the polycrboxylate implants showed decalcification. When placed in osseous tissue. a reaction occurs between the zinc ions and the carboxyl groups on the polyacrylic acid. Herbert recommended zinc phosphate mixed with thymol for immediate root canal fills in conjunction with root-end resection. severe irritation has been reported with the polycarboxylates. However. the liquid is rapidly neutralized by the powder during material set. The available literature on the use of zinc phosphate as a root end filling material: 20 . Therefore. The pH of the cement is approximately 1. with the free carboxyl groups having the capacity to chelate calcium. 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. adhesion to tooth structure is a significant property of these cements. the use of polycarboxylates as root-end filling materials is highly questionable. leak at levels significantly greater than amalgam or gutta-percha. they are well tolerated with no evidence of osteocyte destruction. When placed in subcutaneous tissue. based on their poor sealing ability and uncertain periradicular tissue response. which is probably due to the chelating property of the cement. When the powder and liquid are mixed. 7. Therefore.

21 . irregular pieces of gold foil. particularly with the presence of chronic inflammation in the periradicular tissues. 3) These cements are prone to leakage and are affected by moisture during placement. especially at the gutta-percha sealer-dentin interface. the use of gold foil was recommended because of the ease of direct manipulation.1) it is soluble. This would be a significant problem in root-end fills. especially in dilute organic acids. Cytotoxicity studies have indicated variations in the inhibition of cell growth based on the formulation of the gold. especially in the presence of bacteria. whereas newer formulations (New Biofil and Karat) inhibited up to 80% of the cellular growth. As zinc phosphate does not fulfill most of the properties of an ideal root-end filling material. surface smoothness and tissue biocompatibility. Marginal adaptation and leakage studies have indicated minimal or no leakage. 8. Tissue biocompatibility studies have indicated a mild response to undercondensed. Fine pellet gold did not inhibit cell growth. Studies have shown radiographically field root end resections which had canals filled with gutta-percha and zinc oxyphosphate cement. marginal adaptation. Gold foil: Some of the first reports on gold foil as a root-end filling material is attributed to Schuster in 1913 and Lyons in 1920. The surface of the resection was highly porous. it is not indicated as a root-end filling material. Wilstermann developed a ring-type instrument which could be fit around the resected root end to isolate it from moisture contamination during placement of Goldent. 2) It is irritating to the tissues. Dissolution of he zinc phosphate was obvious serving as a continuous periradicular irritant.

the need for careful placement and finishing. with decreasing toxicity as setting occurs. aluminium polycarboxylates are formed. the possibility of root fracture under excessive condensation pressures and the need for surgeons expertise in material management. Although it possesses favorable material properties. Powder consists of calcium-alumino siliate glass particles and the liquid consists of polyacrylic acid. initiating a prolonged twophase setting reaction. Glass ionomers have also shown to have antibacterial properties. 22 . Marginal adaptation and adhesion of glass ionomer cements to dentin have been shown to be improved with the use of acid conditioners and varnishes. Biocompatibility studies have shown evidence of initial cytotoxicity with freshly prepared samples. Glass Ionomer: They are a hybrid of silicate and polycarboxylate cements which bond physicochemically to dentin and enamel an possess anticariogenic activity. due to their acidity and fluoride release. the routine use of gold foil as a root-end filling material does not appear practical because of the need to establish a moisture free environment. it is recommended to use a water resistant varnish for initial protection during the formation and maturation of aluminium polycarboxylate at the material’s surface. 9. From 30 min to 24 hrs after mixing.Key to the claimed success in the use of gold foil was the close adaptation to the dentinal walls and the ability to highly polish the metal filling. When the powder is mixed with liquid the acid extracts calcium and aluminium ions from the glass particles. It is available as a powder-liquid system. During first 60 min of setting. Therefore. while calcium salts predominate glass ionomers extremely sensitive to moisture contamination and dehydration. Calcium ions bind to the polyacrylic acid producing a firm gel that provides initial adhesion to the tooth structure.

where GIC appeared to perform as well. At 6 month the leakage increased with significant difference between IRM and Fuji IX and no significant difference between other materials. At 6 month the leakage increased with significant difference between IRM and Fuji IX and between MTA and Fuji IX and no significant difference between IRM and MTA was observed. Rosier’s et al.Studies have shown resin modified glass ionomer cements to be better than conventional glass ionomer cements and both of them to be better than cements. which leaked less than IRM. The long term success of GIC as a root end filling material has been confirmed in several studies compared to amalgam. They found that Fuji II LC showed less leakage than (composite) Admira and Admira with boding showed less leakage than Admira alone. Economides et al. At 1 month the leakage decreased with significant difference between IRM and Fuji IX and no significant difference between other materials. in 2004 compared the sealing ability of 2 root end filling materials (Fuji II LC and Admira) with and without the use of dentin boding agents (Fuji bond and Admira bond). in 2005 studied the microleakage of IRM. 23 . Fuji IX and MTA as root end filling materials and found that at 24 hrs Fuji IX leaked less than Pro root MTA. The moist environment does not seem to be detrimental to the surface and GIC seen to be less susceptible to moisture than expected.

whereas Dyract demonstrated statistically less leakage than the other 3 materials. The final results after 180 days showed significantly greater leakage for IRM than Geristore but not for the other materials. The control group was fille with Ketac Silver. Compomers: They are the combination of composites and glass ionomers. Super EAA. Wonnfors in 2004 studied the effectiveness of Dyract AP as a root end filling material. studied the sealing ability of Dyract. No significant difference between IRM and Geristore. Geristore. a light cured compomer and a dental adhesive improves healing regardless of the quality of the remaining root-filling. Charles et al. After 1 day they found greater leakage for super EBA than other materials. in 2001 studied the effect of an acid environment on leakage of Amalgam. The mechanical properties of polyacid modified resin composites are superior to those of traditional glass ionomers and resin-modified glass ionomers and in some cases are equivalent to those of contemporary polymer-based composites. calcium phosphate cement or MTA with calcium phosphate cement. MTA. They concluded that the acid environment did not hinder the sealing ability of the materials tested but in turn enhanced the sealing ability of Geristore and MTA with calcium phosphate cement. Super EBA and IRM. These materials are essentially polymer-based composites that have been slightly modified to take advantage of the potential fluoride-releasing behaviour of glass ionomers. Geristore. 24 .10. with Prime & Bond NT. They cocluded that when used as a root-end filling material in a shallow concave preparation. They conclude that compomers are equal or superior to IRM and equivalent to super EBA in their sealing ability when used as root end filling materials. Pashley et al.

12. 13. composite (Valux plus) and Amalgam (Oralloy) and found biocompatibility with all the materials tested.Ozbas et al. Clinical and radiographic evaluation over 24 months showed results comparable to root-end resection only and slightly better than teeth with root-end guttapercha fills. cyanoacrylate was evaluated as a root-end filling material. in 2003 studied the reactions of connective tissue compomers (F2000 & Dyract). 11. Metallic Retention Pins: Available as a thin metal cap with a vertical loop (similar to an umbrella) is cemented into the prepared apex. Biobond and EDH Adhesive: They are originally used for the prevention of intracranial aneurysm and reinforcement of vessel walls has been evaluated by Nordenram for use as a root-end filling material. 25 . Kinoshita demonstrated adverse tissue response to cyanoacrylate as compared to amalgam and composites with bonding agents. Leakage studies have shown that cyanoacrylate leaked less than amalgam with or without varnish and hot or cold gutta-percha root-end fills. Chloropercha NO is applied between the cap and the cut surface. Cyanoacrylate: Because of bonding properties and soft tissue compatibility. However. Not only would the root canal system be sealed with this technique but also the cut dentin tubules. controversies over the ultimate biocompatibility of cyanoacrylates have minimized its extensive and aggressive use in dental procedures. The perimeter of the cap would encompass the entire resected root face and be flush with the cemental wall.

In vitro studies have shown the cements to have distinct bacteriocidal properties and to exhibit favorable compatibility in tissues culture. However. when placed in the root end. inhibiting DNA synthesis in rat dental pulp cells. Root Canal Sealers: a) Diaket: It is a polyvinyl resin. 26 . used as a root canal sealer and has been recommended by few clinicians as a root-end filling material. was impervious to methylene blue penetration and did not dissolve or absorb in the presence of periradiclar tissues and fluids. On the other hand. Studies have shown that Diaket produced long term chronic inflammation in osseous and subcutaneous tissue and to be cytotoxic in cell culture. compared to amalgam. Diaket is mixed to a thicker consistency than when normally used as a sealer and is condensed into small voids identified in the root canal fill at the resected root surface. Stewart showed that it was tolerated by tissues. 15. Bone Cements: They are polymethacrylate basedand contain an antibiotic (Gentamicin Sulphate). Tetsch has advocated the use of Diaket to enhance a minimally adequate apical seal. they are radiopaque and have been recommended for root-end filling. the sealability of these cements was less than that of amalgam. Gutmann et al. Leakage studies comparing Diaket with non-zinc alloy and two glass ionomers (Ketac fil and Ketac Silver) have shown Diaket to display superior sealing qualities. in 2002 compared Diaket and MTA when use as a root end filing material to support regeneration of the periradicular tissues and found that both Diaket and MTA can support almost complete regeneration of periradicular periodontiim when used as root-end filling materials in periradicular surgery on non-infected teeth.14.

Cell attachment to the surface of the composite was remarkably less than that of amalgam. Siqueire et al. After 60 days leakage was observed in all samples with GIC (Fuji IX). certain composite resins have been advocated as the root-end filing material of choice. They concluded that sealer 26 was more effective in preventing bacterial leakage when compared to other materials tested. 16. 95% samples with IRM and only 65% samples with Sealer 26. in 2001 studied the ability of sealer 26. Creation of a leak-resistant apical seal is possible with this material. The biocompatibility of selected dentin boding agents and composite resins appear favorable and reattachment of periodontal ligament fibres has been reported. composites exhibited a poorer biocompatibility than amalgam. IRM and GIC to prevent bacterial leakage.b) Sealer-26: It is a resinous root canal sealer similar to AH-26 but it contains Ca(OH)2 and not silver. Safavi & associates evaluated cellular attachment to resected root-ends and rootend filling materials (amalgam and composite) in cell culture. Composite resins: Since 1990. Some authors have suggested a slightly concave preparation rather than 27 . cell attachment to the root dentin was highly variable. Overall. Gluma has been shown to have distinct in vivo antibacterial properties that seen to prevent bacterial growth at the tooth-restoration interface. Rud et al have demonstrated excellent long-term clinical success with the use of Retroplast composite resin and Gluma dentin bonding agent. while amalgam whether carved or burnished consistently exhibited marginal gaps. A dry field is necessary for the dentin bonding agent and composite resin root-end fill. Good marginal adaptation was found with composite. although such use is technique sensitive. In addition. Use of dentin bonding agent and composite resin also permits a conservative root end preparation.

a conventional deep cavity followed by subsequent resin bonding to the entire resected root end. This has the advantage of sealing exposed dentinal tubules as well as the main well. All polymerizing resins leave an uncured oxygen-inhibited surface layer that may interfere with initial healing and should therefore be removed with a cotton swab before wound closure. 28 .

Martel et al. MTA in contact with periradicular tissue forms fibrous connective tissue and cementum.17. causing only low levels of inflammation. Because of its high pH similar to that of calcium hydroxide it has a property of induction of hard-tissue formation. Composition:Tricalcium silicate Tricalcim aluminate Tricalcium oxide Silicate oxide Bismuth oxide Tetracalcium aluminoferrrite It is 75% Portland cement to which certain modifiers are added. they suggest MTA as the root end filling material which provides superior seal. They found that MTA and Portland cement show comparative biocompatibility and results suggest that Portland has the potential to be used as a less expensive material but further research and long term follow up has to be carried out. Its pH when set is 12. MTA: It is a powder consisting of fine hydrophilic particles. 29 .5 and its setting time is 2 hrs and 45 min. The sealing ability of MTA has been shown to be superior to that of amalgam or even super EBA. Jacob Saidon et al. Super EBA and MTA. it is not adversely affected by blood contamination. conducted a study to compare the cyttoxic effect in vitro and in vivo and tissue reaction of MTA and Portland cement. The regeneration of new cementum over MTA is a unique phenomenon that has not been reported with other root-end fillings. Therefore. studied the electrical and leakage of IRM. They found less leakage with MTA almost similar to the negative controls.

Excellent biocompatibility. 2. Therefore. They compared 1. they suggest that the thickness of 4mm is the most adequate for the use of MTA as a root-end filling material. Induces hard tissue formation. 4mm MTA was significantly more effective than the other thicknesses tested. Least toxic of all the root end filling materials. 3 & 4 mm thickness of MTA and found that 1mm MTA was the least effective in preventing apical leakage. They found that the freshly mixed MTA was effective in killing the tested fungi after 1 day of contact. Good marginal adaptation.Caroline et al. 5. sets in the presence of moisture and is not adversely affected by blood contamination. 6. Long setting time 2. 3. Disadvantages: 1. 4. studied the influence of the thickness of MTA on the sealing ability as root-end filling material. The use of MTA has many advantages:1. whereas the 24 hr set MTA was effective after 3 days of incubation. No significant difference was found between 2 & 3mm. 7. Good sealing ability. Hydrophilic. Expensive 30 . Difficult to manipulate 3. Saad and Aziza in 2003 studied the anti-fungal activity of MTA. Antibacterial. 2.

Sign up to vote on this title
UsefulNot useful