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MONOBLOC CONCEPT Journal club

IN ENDODONTICS

Presented By
Dr. Laxmi Murkey Guided By

Dr. Vibha Hegde

Dr. Sharad Kokate
Dr. Ushaina Fanibunda
Dr. Ashwin Jain
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Monoblocks in root canals - a hypothetical

or a tangible goal
J Endod. 2007
 The term monoblock, literally meaning a single unit

 Franklin R. Tay first described the concept of

monoblock in endodontics.
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MONOBLOCK

ONE UNIT- GAP FREE

ROOT FILLING MATERIALS POST AND CORE

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 A primary monoblock has only one interface that

extends circumferentially between the material and
the root canal wall.

HEMA containing root

filling material Hydron
(Hydron Technologies)
was marketed
commercially for en
masse filling of root
canals
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 Disadvantage of Hydron

 Hydron was injected - presence of residual moisture

within the root canals .

 Chirila
TV et al stated that HEMA polymerizes in the
presence of water to form soft hydrogels that are highly
permeable and leachable.

 Moduliof elasticity of porous poly(HEMA) hydrogels

such as Hydron ranges from 180–250 MPa
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 Orthograde obturation with mineral trioxide aggregate -primary

monoblock in attempts to strengthen immature tooth roots
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 The compressive elastic moduli of Portland cement increase

after 14 days to 15 GPa (i.e. 15,000 MPa) .

 MTA does not contribute in root strengthening, apart from its

ability to stimulate cementogenesis in apexification and root
end fillings.

 Lack of bonding to dentin, and that although it has high

stiffness in compression, it has little strength in tension
Tay and Pashley

Baek SH, Plenk H Jr, Kim S. Periapical tissue

responses and cementum regeneration with
amalgam, SuperEBA, and MTA as root-end
filling materials. J Endod 2005
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 MTA interacts with dentin by releasing calcium and

hydroxyl ions results in the formation of apatite-like
interfacial deposits .

 orthograde obturations and perforation repair

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Secondary Monoblocks
 Secondary monoblocks are those that have
two circumferential interfaces, one between
the cement and dentin, the other between
the cement and the core material.
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 Thematerials that constitute a monoblock should

have the ability to bond strongly and mutually to one
another, as well as to the substrate with which the
monoblock is intended to reinforce.

 These materials should have moduli of elasticity that

are similar to the substrate.
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 Modulus elasticity of gutta-percha points (ca. 80 Mpa) is

175–230 times lower than that of dentin (ca. 14,000–
18,600 Mpa), making them too plastic (i.e. not stiff
enough) to reinforce roots after endodontic therapy.
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 In
2004 with the advent of bondable root filling
materials that are advocated as alternatives to
conventional gutta-percha were introduced.

 Resilon (Resilon Research LLC, Madison, CT) is a

bondable root filling material that may be used for
either lateral or warm vertical compaction techniques
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Resilon - polycaprolactone - Epiphany Sealer. Primer &

based, dimethacrylate resin– a dual cure sealer
contains Bioactive glass
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 Initial
studies on Resilon-filled root canals were
highly favorable.

 Resilon Monoblock System (RMS) that produces

ideal root obturations in terms of coronal sealing and
fracture resistance
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 Itwas studied later that large polymerization

stresses during their setting that may cause
debonding and gap formation along the periphery of
the root filling.

 The extremely high C-factor(above 1000) in root

canals has been cited as a possibility for not
achieving perfect seals in Resilon-filled root canals

Tay FR, Loushine RJ, Lambrechts P, Weller RN, Pashley

DH. Geometric factors affecting dentin bonding in root
canals: a theoretical modeling approach. J Endod
2005;31:584–9
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 Also it lacks a free radical-containing oxygen

inhibition layer - its bondability to resin- based
sealers has further been questioned

Tay FR, Hiraishi N, Pashley DH, Loushine RJ,

Weller RN, Gillespie WT, Doyle MD. Bondability
of Resilon to a methacrylate-based root canal
sealer. J Endod 2006;32:133–7.

Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay

FR, Ferrari M. Interfacial strength of Resilon and
gutta-percha to intraradicular dentin. J Endod
2005;31:809–13.
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 There is no difference between Resilon and gutta-percha in

strengthening and reinforcement of immature roots.

 The modulus of elasticity of Resilon was found to be 86.6 ±

43.2 MPa under dry conditions and 129.2 ± 54.7 MPa after one
month of water sorption .

 Thus, similar to gutta-percha, Resilon is not stiff enough to

achieve a mechanically homogeneous unit with root dentin

Williams C, Loushine RJ, Weller RN, Pashley

DH, Tay FR. A comparison of cohesive strength
and stiffness of Resilon and gutta-percha. J
Endod 2006;32:553–5
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Is Resilon the Solution?

• Studies have shown conclusive evidence of Resilon

being equally effective or even superior to gutta-
percha based systems however long-term studies on
leakage comparing gutta-percha and Resilon-based
systems have shown they showed more fluid
movement when tested at 16 months.

IEJ 2007
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• The question of biocompatibility of periapical

tissues with resin-based systems and leaching of
resin by-products still exists.

• So, due to the nonresorbable nature of resins, the

removal of obturating material in the cases of
overfills is a major concern.
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Tertiary Monoblocks

 An additional circumferential interface is introduced

by coating the non-bondable gutta-percha points
with materials that render them bondable to the root
canal sealers.
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In the EndoRez system (Ultradent, South Jordan, UT)

Diisocyanate

Isocyanato group – binds

isocyanato group - the
hydroxyl group of a
hydroxyl-terminated
polybutadiene -
hydrophobic component-
binds to the gutta-percha
cones
to the hydrophilic
methacrylate functional
group producing a gutta-
percha resin coating that
is bondable to a
hydrophilic,
methacrylate-based dual-
cured resin sealer.
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To-date, leakage and morphologic studies showed

that the seal of system is mediocre.

 polymerization shrinkage of the methacrylate-

based sealer .

 sealer bonds weakly to the pre-polymerized

proprietary coating – absence of oxygen inhibition
layer.

 Since the external proprietary resin coating is

uneven there can be partial detachment

J Adhes Dent 2005

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 In ActiVGP (Brasseler)- used with conventional

gutta-percha cones that are surface-coated with
glass ionomer fillers using a proprietary technique.

 Itcan be bonded to the root dentin via a glass-

ionomer sealer

Dent Today 2006

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 However, being a single cone technique,

coronal leakage of the ActiV GP system to
fluid filtration was worse than that achieved
with gutta-percha/AH Plus.

Monticelli F, Sword J, Martin RL, Schuster GS, Weller RN,

Ferrari M, Pashley DH, Tay FR. Sealing properties of two
contemporary single-cone obturation systems. Int Endod
J. in press
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• Hydrophilic polymer in the root canal, The

Smart-Seal System (endotechnologies,USA).

• The system consists of premade obturation

points (C-Points) containing a polyamide
core with an outer bonded hydrophilic
polymer coating.

• The polymer coating is a cross-linked

copolymer of acrylonitrile and vinylpyrrolidone
which has been polymerised and cross-
linked using allyl methacrylate and a thermal
initiator
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• The inner core is composed of two proprietary

nylon polymers: Trogamid T and Trogamid CX.

• Smartpaste bio is a resin based sealer designed

to swell through the addition of bioceramic filler
particles.
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 Smartpaste bio produces calcium hydroxide and

hydroxyapatite as by- products of the setting
reaction, rendering the material both anti-bacterial
while setting and very biocompatible once set.

 Also, it is hydrophilic in nature, allowing the C-

point to hydrate and swell to fill any voids.
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• The use of expandable obturating materials to

improve the seal of the root-filled canals

• Hydrophilic obturations of the root canal shows a

better resistance to bacterial leakage as compared
to hydrophobic obturations.

JCD 2015
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Monoblock in post and core

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• A customized polyethylene fibre post-core system

such as Ribbond (Ribbond Inc., Seattle, WA,USA)
can create a primary monoblock in a root

• It has a elastic modulus of 23.6 GPa (Eskitascioglu

et al. 2002) therefore, too high elastic modulus
creates interfacial stresses along the resin dentin
interface.
+ POLYETHYLENE FIBRE POST-CORE
35
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 Microleakage
studies comparing different dowel
systems was done using fluild filtration test.

 Glass fibre and ribbond posts should least

microleakage when compared to zirconia and
stainless steel.
J Prosthet Dent 2004

 Fracture
resistance was better in glass fibre post as
compared to ribbond posts

Clin oral investig 2012

+ Prefabricated post systems bonded to
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root canal dentine via resin cements

represent a secondary monoblock

First implied existence of a mechanically homogeneous

monoblock is reported in 1996 with the bonding of
epoxy resin– based, carbon fiber–reinforced posts to
root dentin .
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• Epoxy- resin based matrices – did not bond to

methacrylate cements

• Carbon-fibre posts are black in colour and do

not lend themselves to aesthetic restorations
with all-ceramic units.

• These posts are also called glass-fibre and

quartz-fibre
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In the fibre posts the epoxy resin

matrix are replaced with highly
cross-linked , methacrylate resin
matrices that have the potential to
bond to methacrylate-based resin
cements
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 Since resin cements exhibits less microleakage and bond to

the tooth structure as compared to other cements
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Tertiary monoblock = Fibre post + external silane

Fiber posts that contain an external silicate coating

(DT Light SL, VDW GmbH, Munich, Germany),

Anatomic Post R(TD, St. Egéve, France) may be

considered as tertiary monoblocks
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Coating made of silane and

silicate is applied to the post

DT Light SL
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The adhesion between prefabricated FRC posts

and composite resin cores with and without post-
silanization was studied.

 For better adhesion , salinization is advisable

Choi et al. found that no additional surface

treatment is needed .

J.dent mater 2005

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‘ANATOMIC POST’
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• Theoretically, a reduction of the resin cement thickness should

result in a reduction of volumetric shrinkage.

• Polymerization shrinkage stresses along the cavity walls are

also present in a low compliance environment

• Introduction of a tertiary interface is problematic in that gaps

were found to be present between the fiber post and the relining
composite.

• These gaps may can act as stress raisers and result in eventual
adhesive failure and dislodging of the fiber post from the relining
composite.
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CONCLUSION

Thus, until non-shrinking composites are available the

pursuit of an ideal monoblock for reinforcing the root canal
may be viewed as an ideal goal.
+ Monoblocks in root canals: a finite elemental stress
48

analysis study
2011 International Endodontic Journal

Aim
To investigate using finite element stress analysis (FEA)
primary, secondary and tertiary monoblocks created
either by adhesive resin sealers or by different adhesive
posts and to evaluate the effect of interfaces on stress
distribution in incisor models
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(a) primary monoblock - Mineral Trioxide Aggregate

(b) Secondary monoblock - (MetaSEAL) and Resilon

(c)tertiary monoblock – EndoREZ

(d) primary monoblock - polyethylene fibre post-core (Ribbond)

(e) secondary monoblock - glass-fibre post and resin cement

(f) tertiary monoblock - bondable glass- fibre post

(g) tertiary monoblock - silane-coated ceramic post

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A 300 N load was applied from the

palatal surface of the crown with a 135
angle to the
tooth long axis.
Measured in von Mises stress unit
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RESULT
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DISCUSSION

 Stresses within roots increased with an increase

in the number of the adhesive interfaces.

 Creation of a primary monoblock within the root

canal reduce the stresses that occur inside the
tooth structure.
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• The palatal side of the MTA - decreased stress

accumulation (8.33–13.3 MPa)

• Composite resin in the access cavity has

increased stress at the coronal region.

• The MTA-treated model revealed that the material

kept the stress inside of the material body (1.67–
3.33 MPa) and directed towards the root.
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• The polyethylene fibre post-core system is considered to

create primary monoblocks in the present study.

• Von Mises stress values indicated that the stress

occurring coronally was high in primary monoblock model

• No stress was directed towards the root.

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secondary monoblock model revealed stress accumulation at the

interface between the Resilon and MetaSEAL
(13.3–20 MPa)

 Even the adhesive procedures alone are not

sufficient to strengthen dentine if the material is not
stiff enough (Grande et al. 2007)
+ • Debonding of posts because of contraction stress of
57

(Cagidiaco et al. 2008).

• Shrinkage stresses that occur with polymerization of

methacrylate-based resins specially in deep, narrow
canals

In the present study it was demonstrated that as

the number of interface increases the stresses
also increase but the distribution of stresses
were close to that of natural tooth.
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Fibre posts that contain an extra silicon coating such

as DT Light (VDW) or ceramic posts that require a
silane coating such as Cosmopost (Ivoclar) - tertiary
monoblocks.

• Stress values along the cement glass-fibre or ceramic

interface ranged from 1.67 to 15 Mpa for tertiary
monoblock models

• Furthermore, the stress was directed through the root.

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• Ceramics used for post fabrication present moduli of

elasticity that are above that of dentine
(Dietschi et al. 2007).
• The failure mode is mostly non-restorable (Eskitascioglu
et al. 2002, Maccari et al. 2003).

• Catastrophic fractures
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Concept of monoblock is
hypothetical

Accomplishing these “ideal monoblocks” in the root canal space is easier said than
done.
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Problems associated

o Over-thinning of the adhesive

o Even the entrapment of water droplets between the adhesive

and resin cements/sealer introduces crack tips in fracture
toughness testing .

o They can act as stress raisers that promote crack growth and
propagation during loading along the interface.

J Biomed Mater Res B Appl Biomater 2006

J Endod 1998
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“The goal of being able to bond a canal

from the minor constriction to the canal
orifice to the occlusal surface is a
desirable one”
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