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Gutta-percha in endodontics - A comprehensive review of material science

Article  in  Journal of Conservative Dentistry · May 2019

DOI: 10.4103/JCD.JCD_420_18

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Review Article

Gutta-percha in endodontics - A comprehensive

review of material science
Vijetha Vishwanath, H Murali Rao
Department of Conservative Dentistry and Endodontics, D. A. Pandu Memorial RV Dental College, Bengaluru, Karnataka, India

Abstract
The complete and three-dimensional fluid tight seal of the root canal system is the final component of the endodontic triad.
The long-standing and closest material which has fulfilled this criterion is gutta-percha (GP). Several materials have been tried
and tested as an endodontic filling material, of which GP has been most extensively used for years and has established itself
as a gold standard. In addition, it has proved itself successful with different techniques of obturation while maintaining its
basic requisites. This article deals briefly with the history and evolution of GP, source, chemical composition, manufacturing,
disinfection, cross-reactivity, and advancements in the material.
Keywords: Endodontics; gutta-percha; material science

INTRODUCTION further introduced GP to the West. His work was referred

There is always on-going research for newer endodontic
obturating materials to obtain better materials than the
existing ones to fulfil the biological requisites along with
predictable long-term treatment outcome. Several materials
have been tried and tested for filling the root canal. The results
were variable, from satisfactory to disastrous, at times. Of
all the tested materials, gutta-percha (GP) has stood the test
of time for years with consistent clinical performance under
various clinical situations across the world. As of now, no
other materials can be considered as a possible replacement
for GP in its various forms. Hence, GP can be considered as a
gold standard material for obturation.
to the Medical Board of Calcutta and was awarded a gold
medal by The Royal Society of Arts in London. The first
patent for GP was obtained in 1864 by Alexander, Cabriot,
and Duclos, which opened a Broadway for its industrial
use. In 1845, Hancock and Bewley formed the GP Company
in United Kingdom. People became infatuated with this
new material and it became the first successful insulation
for an underwater cable. Its use multiplied rapidly for
manufacture of corks, pipes cements, thread, surgical
instruments, garments, musical instruments, suspenders,
window shades, carpets, gloves, mattresses, pillows, tents,
umbrellas, golf balls (gutties), sheathing for ships, and
boats were made wholly of GP.[1]

HISTORY EVOLUTION OF GUTTA-PERCHA IN

DENTISTRY
History shows that GP has been used for a variety of purposes
since the 17th century. Around 1656 an English natural • 1846 - Alexander Cabriol surgical uses
historian John Tradescant introduced GP to Europe and • 1847 - Edwin Truman-GP-Temporary filling material
called it “mazer wood.” In 1843, Dr. William Montgomerie • 1847 - Hill-Hill’s stopping restorative material-Mixture
of bleached GP, carbonate of lime and silica[2]
Address for correspondence: • 1849  -  Chevalier, Poiseuille and Robert-GP tissue
Dr. Vijetha Vishwanath, Department of Conservative Dentistry
(laminated sheets)-Academy of Medicine, Paris
and Endodontics, D A Pandu Memorial RV Dental College and
Hospital, JP Nagar, Bengaluru - 560 078, Karnataka, India. • 1864 - First patent by Alexander, Cabriot, and Duclos
E-mail: vizzz.92@gmail.com
Date of submission : 20.09.2018 This is an open access journal, and articles are distributed under the terms
Review completed : 20.11.2018 of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Date of acceptance : 16.04.2019 License, which allows others to remix, tweak, and build upon the work
Access this article online non-commercially, as long as appropriate credit is given and the new
Quick Response Code: creations are licensed under the identical terms.
Website:
www.jcd.org.in For reprints contact: reprints@medknow.com

How to cite this article: Vishwanath V, Rao HM. Gutta-percha

DOI: in endodontics - A comprehensive review of material science.
10.4103/JCD.JCD_420_18
J Conserv Dent 2019;22:216-22.

216 © 2019 Journal of Conservative Dentistry | Published by Wolters Kluwer - Medknow

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Table 1: Chemistry
Natural rubber
“Cis” polyisoprene
CH2 groups on the same side of the double bond to form the polymer of
natural rubber
More kinked, which complicates alignment, allows for mobility of one chain
with respect to another, and gives natural rubber its elastomeric character
• 1867  -  Bowman-root filling material-St Louis Dental
Society
• 1883 - Perry-Softened GP with gold wire
• 1887 - S. S. White Co.-Manufacture of GP
• 1893  -  William Herbt Rollins-Modified GP with
Vermillion
• 1911  -  Webster-Heated GP-Sectional method of
obturation
• 1914 - Callahan-Softening and dissolution of GP
• 1959 -  Ingle and Levine-Standardized root canal
instruments and materials
• Standardized GP  -  2nd International Conference of
Endodontics at Philadelphia
• 1967 - Schilder-Warm vertical compaction
• 1976 - International standards organization group for
approval of specification of endodontic instruments
and materials
• 1977 - Yee et al.-Injectable Thermoplasticized GP
• 1978 - Ben Johnson– Carrier based GP-Thermafil
• 1979 - McSpadden-Special compactor-Softening of GP
by frictional heat
• 1984  -  Michanowicz-Low temperature Injectable
GP-Ultrafils
• 2006 - ANSI/ADA specification-GP cones-No.78.[3]
Some of commercially available GP points brand from earlier
period (1970s) were manufactured by companies such as
Dent-O-Lux, Indian Head, Mynol, Premier, and Tempryte.
More recently, brands such as Tanari (Tanariman, Brazil),
Meta (GN Injecta, Brazil), Dentsply (York, USA), Roeko
(Coltene, Switzerland), Diadent (Korea), and Sybronendo
(Orange, California) are popular since the evolution of NiTi
rotary endodontic systems.
Apart from GP the alternate materials which have
been tried are plastics (Resilon), solids or metal cores
(Silver points, Coated cones, Gold, Stainless Steel,
Titanium and Irridio-Platinum), and cements and pastes
(Calcium Phosphate, Gutta Flow, Hydron, MTA). However,
many of these materials do not meet the complete
requirements for obturation of root canal systems. Only
calcium silicate-based materials like MTA and related
bioactive cements have shown promising results.
SOURCE
GP is a dry coagulated sap of a peculiar species of tropical
plants. It was first obtained from Sapotaceae family of
Journal of Conservative Dentistry | Volume 22 | Issue 3 | May-June 2019
Vishwanath and Rao: Review of gutta-percha
Gutta percha
“Trans” polyisoprene
CH2 (Methylene group), groups on opposite sides of the
double bond to form the polymer known as gutta‑percha
More linear and crystallizes more readily. Consequently,
harder, more brittle, and less elastic than natural rubber
trees, which are abundant in the Malay Peninsula (South
East Asia). In Malay-getah perca means “percha sap” (plant’s
name). The trees are mainly found in Malay Archipelago,
Singapore, Indonesia, Sumatra, Philippines, Brazil, South
America, and other tropical countries. These trees are
medium to tall (approximately 30 m) in height, and up to
1 m in trunk diameter. It is usually imported from Central
South America for its use in dentistry, which is one of the
reasons for its high cost.[4]
There are many species of Palaquium genus that yield GP of
which four are found in India:
1. P. obovatum-Assam
2. P. polyanthum-Assam
3. P. ellipticum-Western ghats
4. P. gutta-Lalbagh Botanical garden, Bengaluru, Karnataka.
COMPOSITION
GP is a trans-isomer of polyisoprene. Its chemical structure
is 1, 4, trans–polyisoprene. The molecular structure of GP
is close to that of natural rubber from Hevea brasiliensis,
which is a cis-isomer of polyisoprene. Both are high-
molecular-weight polymers and structured from the same
basic building unit or isoprenemer [Table 1].[1]
MANUFACTURE
A series of “V” shaped or concentric cuts are made on the
bark for the collection of milky juice in Areca palm conic
receptacles. The juice is put into a pot and boiled with a
little water to prevent its hardening on exposure to air. It
is then boiled and kneaded under running water to remove
particles of wood and bark; rolled into sheets to expel the air
enabling it to dry quickly. It is placed in a revolving masticator
and heated until it is fit for use. The chemical method of
coagulation is by the addition of alcohol and creosote mixture
(20:1), ammonia, limewater, or caustic soda.[2]
Obach’s technique
• The obtained pulp is heated to 75°C in the presence of
water to release the GP threads (Flocculated GP known
as “yellow gutta”) and then cooled to 45°C
• At below 0°C temperature, this yellow gutta is mixed
with cold industrial gasoline to dissolve the resins and
denature any residual proteins
• This mixture is dissolved in warm water at 75°C, and
dirt particulates are allowed to precipitate
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Vishwanath and Rao: Review of gutta-percha
• The residual greenish-yellow solution is bleached with
activated clay, filtered to remove any particulate, and
then steam distilled to remove the gasoline
• The final commercially available formulation is “Final
ultra-pure” (white) GP modified with appropriate fillers
to overcome the odor of gasoline
• It is finally combined with fillers, radiopaque material,
and plasticizers to obtain GP cones for endodontic
procedures with the composition of 20% GP, 56% zinc
oxide filler, 11% radiopacifier (barium sulfate), and 3%
plasticizers (waxes or resins).[2]
In crude form, its composition is made of Gutta (75%–82%),
Alban (14%–16%), Fluavil (4%–6%), and also tannin, salts, and
saccharine. The elasticity of GP and its plasticity at elevated
temperature is determined by Gutta. Alban does not seem
to have any harmful effect on the technical properties of
GP. Fluavil is a lemon-yellow, amorphous body, having the
composition (C10H16O). When it occurs in gutta in larger
quantities it renders this material brittle.
It is relatively easy to make GP sticks as not much of precision
is required. However, to make endodontic cones, the
precision of standardization has to be maintained. It requires
a special technology where all ingredients are blended and
passed through the specification molds running under high
vacuum suction or by injection molding and hand rolling.[2,4]
CHEMICAL PHASES OF GUTTA-
PERCHA
C.W Bunn in the year 1942, reported that the GP polymer
could exist in two distinctly different crystalline forms,
which he termed “alpha” and “beta” modifications. These
forms were “trans” isomer, differing only in single bond
configuration and molecular repeat distance, and hence
could be converted into each other.
The “alpha” form occurs in the tree, which is the natural form.
Most of the commercially available products are in the “beta”
form. When the alpha form is heated >65°C, it becomes
amorphous and melts. If this amorphous material is cooled
rapidly, β form recrystallizes whereas if it is cooled extremely
slowly (0.5°C/h), α form recrystallizes. The beta form becomes
amorphous when heated at 56°C, which is a considerable 9°
less than the melting point of the alpha form and the factor
determining the melting point of “alpha” and “beta” GP is
the rate of cooling which, in turn, controls the extent and
character of crystallinity in the material formed [Table 2].[5]
PHYSICAL AND THERMO-
MECHANICAL PROPERTIES
GP is a thermoplastic and viscoelastic material which
is temperature sensitive. At ranges of ambient room
218 Journal of Conservative Dentistry | Volume 22 | Issue 3 | May-June 2019
temperature, it exists in a stiff and solid state. It becomes
brittle on prolonged exposure to light and air due to
oxidation. It becomes soft at 60°C and it melts around
95°C–100°C with partial degradation. Decrease in
temperature increase the strength and resilience and vice
versa, especially when temperature exceeds 30°C.[6] The
physical properties of tensile strength, stiffness, brittleness,
and radiopacity depend on the organic (GP polymer and
wax/resins) and inorganic components (zinc oxide and
metal sulfates). Zinc oxide increases brittleness, decreases
percentage elongation and ultimate tensile strength.[7]
An account of the tensile strength of GP gives a reliable
measure of its properties than compressive tests. Materials
with the predominant property of ductility do not exhibit
repeatable values for compression on account of resulting
complicated stress patterns.
The property of viscoelasticity is critical during condensation
of GP in obturation procedures which permits plastic
deformation of the material under continuous load causing the
material to flow.[6] The transformation temperatures of dental
GP are 48.6°C–55.7°C for the β-to the α-phase transition, and
59.9°C–62.3°C for the α-to the amorphous phase transition,
depending on the specific compound; heating dental GP to
130°C causes physical changes or degradation.[8]
An account of average values of few physical properties of
some clinically usable GP points from various manufacturers
is tabulated below. However, continuous modifications
have been attempted over the years by the addition of
various materials to improve the properties to result in
better clinical performance [Table 3].[6]
PHYSICAL FORMS OF GUTTA-PERCHA
1. Solid core GP points
Table 2: Characteristics
Phases Properties
Alpha (α) form Brittle at room temperature
Gluey, adhesive and highly flowable when heated
(lower viscosity)
Example: Thermoplasticised gutta‑percha used for
warm condensation obturation technique
Beta (β) form Stable and flexible at room temperature
Less adhesive and flowable when heated (high viscosity)
Example: Commercially available gutta‑percha used
for cold condensation obturation techniques
Gamma (γ) form Similar to α‑ form, unstable
Table 3: Physical properties of Gutta percha
Physical properties Average values
Yield strength 1000‑1300 psi
Resilience 40‑80 in/lb
Tensile strength 1700‑3000 psi
Elastic modulus 15,500‑28,000 psi
Flexibility 0.07‑0.12 in/lb
Elongation (%) 170‑500
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Available as standardized and non-standardized points
(beta phase).
• Standardized points: Correspond to instrument
taper and apical gauge
• Nonstandardized points: Variable taper, the tip of
point to be adjusted after apical gauging to obtain
an optimum fit and apical seal.
Used with cold lateral condensation with warm vertical
compaction.
2. Thermomechanical compactable GP
3. Thermo plasticized GP:
Available in injectable form (alpha phase). Special
heaters are provided in the systems to attain flowable
temperature of GP. The apical seal is accomplished with
the plugging of master cone and then the injectable GP
is backfilled.
• Solid core system
• Injectable form.[2]
4. Cold flowable GP.
It is eugenol-free, self-polymerizing filling system in which
the gutta percha in powder form is combined with a resin
sealer in one capsule. It exhibits viscoelastic property of
thixotropism and therefore has a better flow under shear
stress which, in turn, provides good sealing ability.
MODIFICATIONS OF GUTTA PERCHA
Attempts have been made to obtain optimum seal and
therapeutic effects by addition of various materials
[Figure 1].
Surface modified gutta percha
One of the drawbacks of GP is lack of true adhesion. Hence,
improvization for enhanced adaptability of GP has been
attempted by surface modification with the following materials.
• Resin coated - A resin is created by combining
diisocyanate with hydroxyl-terminated polybutadiene,
as the latter is bondable to hydrophobic polyisoprene
(PI). This is followed by the grafting of a hydrophilic
methacrylate functional group to the other isocyanato
group of the diisocyanate, producing a GP resin coating
that is bondable to a methacrylate-based resin sealer[9]
Figure 1: Types of modified gutta percha
Journal of Conservative Dentistry | Volume 22 | Issue 3 | May-June 2019
Vishwanath and Rao: Review of gutta-percha
• Glass ionomer coated-Results in a true single cone
monoblock obturation. Glass ionomer creates an ionic
bond with the dentin, is nonresorbable and not affected
by the presence of residual sodium hypochlorite
• Bioceramic coated-Bioceramic materials are
incorporated and coated onto GP points which are
available in specific sizes. They enhance the quality of
obturation along with specific hydrophilic bioceramic
sealers. These materials are in the form of nano
particles (calcium phosphate silicates) to increase their
activity and to bring about better sealing by taking
advantage of the natural moisture of dentin. These
kinds of obturation bring about slight expansion rather
than the usual shrinkage, which actually is beneficial to
seal the canals[10]
• Nonthermal plasma-Argon and oxygen plasma sprayed
to GP improve the wettability of GP by the sealer,
favoring adhesion. Argon plasma led to chemical
modification and surface etching while oxygen plasma
increased surface roughness.[11]
Medicated gutta-percha
• Iodoform: IGP contains 10% iodoform (CHI3), a
crystalline substance, which is soluble in choloroform
and ether but low solubility in water. They interact with
cell walls of microorganisms causing pore formation or
generate solid-liquid interfaces at the lipid membrane
level, which lead to loss of cytosol material and
enzyme denaturation. It is said to inhibit the growth of
Staphylococcus aureus, Streptococcus sanguis, Actinomyces
odontolyticus, and Fusobacterium nucleatum, but not
Enterococcus faecalis, Escherichia coli and Pseudomonas
aeruginosa[12]
• Calcium hydroxide: Calcium hydroxide Gutta percha
(CGG) points combine the efficiency of calcium
hydroxide and bio-inertness of GP to be used as
temporary intracanal medicaments. The action is
directly correlated to the pH which is influenced by
the concentration and rate of release of hydroxyl ions.
When used as an intra-canal medicament in endodontic
therapy, moisture in the canal activates the calcium
hydroxide and the pH in the canal rises to the level
of 12+ within minutes. The resultant antimicrobial
effects may be evident within 1–4 weeks[13]
• Chlorhexidine: Chlorhexidine (CHX) is a broad-
spectrum anti-infective agent which is a synthetic
cationic bis-guanide. It acts by the interaction of
the positively charged CHX molecule and negatively
charged phosphate groups on microbial cell walls
causing a change in osmotic equilibrium. CHX is
both bacteriostatic (0.2%) and bactericidal (2%) and
can penetrate the microbial cell wall by altering its
permeability. Chlorhexidine impregnated GP points
(Activ points) are known to be effective against E.
faecalis and Candida albicans[14]
• Tetracycline: Tetracycline Gutta percha (TGP) contains
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Vishwanath and Rao: Review of gutta-percha
20% GP, 57% zinc oxide, 10% tetracycline, 10% barium
sulfate, and 3% beeswax. They remain inert pending
contact with tissue fluids; gets activated and become
available to inhibit any bacteria that remain in the root
canal or those that enter the canal through leakage.
The greatest antimicrobial effect was seen on S. aureus
and less on E. faecalis and P. aeruginosa[15]
• Cetylpyridinium chloride (CPC): CPC, a quaternary
ammonium compound and a cationic surfactant,
has been used in antiseptic products and drugs.
Although the antimicrobial mechanisms of CPC are
not well understood, it appears to damage microbial
membranes, thereby eventually killing microbes.
Addition of CPC improved the antimicrobial property
of GP in proportion to the amount added. However,
this GP is not commercially available yet.[16]
Nanoparticles enriched gutta-percha
The era of nanotechnology has turned into the best
innovation in the fields of health sciences and innovation.
Nano is derived from the Greek word “υαυος” which
means dwarf, and it is the science of producing functional
materials and structures in the range of 0.1 nm to 100 nm.
Nano particulates show higher antibacterial action on
account of their polycationic or polyanionic nature, which
expands their applications in various fields.
Nanodiamond-gutta-percha composite biomaterials
Nanodiamond-GP composite embedded with nanodiamond
amoxicillin conjugates was developed which could reduce
the likelihood of root canal reinfection and enhance the
treatment outcomes. NDs are carbon nanoparticles that
are roughly 4μ - 6nm in diameter. It is a biocompatible
platform for drug delivery, and they have demonstrated
antimicrobial activity. Due to the ND surface chemistry,
a broad-spectrum antibiotic, such as amoxicillin, can
be adsorbed to the surface facilitating the eradication
of residual bacteria within the root canal system after
completion of obturation. The homogeneous scattering of
NDs all through the GP matrix increases the mechanical
properties, which enhance the success rate of conventional
endodontic therapies and reduce the need for additional
treatments, including retreats and apical surgeries.[17]
Silver nanoparticles coated gutta-percha
Silver (Ag) ions or salts possess sustained ion release,
long-term antibacterial activity, low toxicity, good
biocompatibility with human cells and low bacterial
resistance. Dianat and Ataie have introduced nanosilver
gutta-percha in an attempt to upgrade the antibacterial
effect of GP, where the standard GP is coated with nanosilver
particles. It demonstrates a significant antibacterial effect
against E. faecalis, Staphylococcus aurous, Candida albicans,
and E. coli.[18]
220 Journal of Conservative Dentistry | Volume 22 | Issue 3 | May-June 2019
CLINICAL CONSIDERATIONS
Disinfection of gutta-percha
Handling, aerosols, and physical sources during the storage
process can contaminate GP. The conventional process
in which moist or dry heat is used cannot sterilize GP
because this may cause irreversible physical or chemical
alteration to the structure. Rapid chairside chemical
disinfection is needed as the amount of GP points needed
cannot be predicted beforehand. Sodium hypochlorite,
glutaraldehyde, alcohol, iodine compounds, and hydrogen
peroxide have been tried as GP cones disinfectant. The
time ranges from a few seconds to substantial periods
for these substances to kill microorganisms. NaOCl at
5.25% concentration is an effective agent for a rapid high
disinfection level of GP cones. 2% CHX kills all vegetative
forms in a short period but did not eliminate Bacillus subtilis
spores within the times tested.[19] 2% peracetic acid solution
is effective against some microorganisms in biofilms on GP
cones at 1 min of exposure.[20]
Herbal extracts such as lemon grass oil, basil oil, and obicure
tea extract, are probable alternatives for chairside disinfection
of GP cones and have shown good results.[21] Ethanolic extracts
of Neem, Aloe vera, and Neem + Aloe Vera have been seen to
be successful in decontaminating GP cones against E. coli and
S. aureus (common contaminants of GP cones).[22]
Removal of gutta-percha
GP solvents are used during retreatment or solvent based
obturation technique as attempt in complete mechanical
removal may cause perforation, straightening of canals
or change in the internal anatomy compromising the
tooth and treatment outcome. Benzene and carbon
tetrachloride have been discontinued as solvents due to
their toxicity. Others include eucalyptol oil, chloroform,
methylchloroform, and xylene. The eucalyptol oil does
not effectively dissolve GP at room temperature and has
to be heated to act relatively fast. Hence, it not widely
used. Chloroform is preferred due to volatility, cost,
availability, better odor, and compatibility with zinc
oxide-eugenol-based root canal sealers. Trichloroethylene,
cineole, orange oil, Coe Paste Remover, halothane,
anise oil, anethole, bergamot oil, terpineol in cineole,
chlorobutanol in cineole, methoxyflurane, and diethyl
ether have been tried and tested.[23]
BIOLOGICAL PROPERTIES AND TISSUE
INTERACTION
Cross-reactivity
GP and gutta-balata are derived from the same botanical
family as the rubber tree, and related to latex. It is
reported that occasionally in the short supply of GP, the
manufacturers add some amount gutta-balata or synthetic
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trans-polyisoprene to the GP cones which is not disclosed.
It is seen that raw gutta-balata releases proteins that
cross-react with Hevea latex and the use of a gutta-balata-
containing product could potentially place a high latex
allergic patient at risk for an allergic reaction even when
proper instrumentation and obturation techniques are
used to confine the material within the root canal system.[24]
Reaction of dental pulp
GP has been used as a temporary restorative material
owing to its ease of placement and removal. The teeth
become sensitive after its insertion into the dentin. Some
of the teeth were extracted in an experimental study, and
the histologic picture showed pathologic reaction in the
pulp tissue, which changed with increasing observation
period. The most typical reactions were:
a. Odontoblast nuclei in the pulpal ends of the cut
dentinal tubules [Table 4]
b. A break in the continuity of the pulp dentinal membrane
c. Neutrophilic leukocytes along the predentine border, in
the odontoblast layer and in the adjacent layer of Weil
d. Capillaries in the odontoblast layer were filled with
blood, and in most cases extravasated erythrocytes
were scattered along with neutrophilic leukocytes and
lymphocytes.[25]
Reaction of connective tissue
GP has been the least irritating root canal filling material till
date. Fibrous encapsulation, calcification, and foreign-body
reactions are some of the common responses to GP extruded
into the periapical tissues. Small amounts of plasticizers, age
resisters, coloring agents, and other additives do not play a
major role in influencing the irritational qualities of GP cones.
An inflammatory reaction is found only when an irritating
material made up a significant percentage of the cone, as in
calcium hydroxide enriched GP points. Therefore, the use of
other additives should be kept to optimum levels.[26]
Reaction of gingival fibroblast and epithelial
tumor cells
Increased connective tissue invagination with better
healing of periradicular lesions have been attributed to
calcium hydroxide and chlorhexidine-containing GP. Some
authors described the destruction of epithelial tumor cells
if present in periradicular lesions. Direct exposure of cells to
Table 4: Merits and demerits of gutta percha
Merits Demerits
Compactible Lacks rigidity
Inert Lacks adhesive quality
Can be softened Does not bond to sealers by itself
Dimensional stability Easily displaced by pressure
Tissue tolerant Lack of length control
Radiopaque
Easily removed
Antibacterial
Readily sterilizable
Journal of Conservative Dentistry | Volume 22 | Issue 3 | May-June 2019
Vishwanath and Rao: Review of gutta-percha
the above materials has shown changes in cell morphology.
The release of prostaglandin has been described as a
helpful marker of inflammatory processes in pulp tissue.
Conventional GP points have nonsignificant effect on the
prostaglandin release by gingival fibroblasts. On contrary,
some studies have shown that GP points containing calcium
hydroxide or chlorhexidine, led to an inhibition of gingival
fibroblast growth. Exposure of epithelial tumor cell cultures
to the various tested materials led to morphological cell
irregularities and influenced the proliferation patterns.[27]
Scaffolds
GP materials are primarily used for obturation, their
interaction with living tissues is still being studied.
Polybutadiene, a polymer with similar chemistry to PI,
the base material of GP induces differentiation of dental
pulp stem cells (DPSC), when its properties were modified
by ZnO nanoparticles and dexamethasone. However,
the mechanical strength and roughness imparted by the
nanoparticles contributed to promoting differentiation of
DPSC placed in contact with the material surfaces. It is
probable that in addition to obturation, GP nanocomposites
can act as scaffolds for dental tissue regeneration.[28]
MERITS AND DEMERITS OF GUTTA-
PERCHA
Table 4 Merits and Demerits of gutta percha.
OTHER USES OF GUTTA-PERCHA
Assessment of pulp status
Thermal stimulation is a standard means of assessing the
vitality of teeth and hot GP has conventionally been the
most popular. As controlled temperature is difficult to
attain, it is imperative that heated GP should not be in
contact with the tooth surface for more than 3–5 s, else may
result in damage of an otherwise healthy pulp. Rickoff et al.
showed that GP used as above-increased pulp temperature
only <2°C for <5 s of application – a temperature change
that is unlikely to cause pulp damage.[29]
Tracing sinus tract
GP points are used to trace through sinus tracts to locate
the source of infection and the offending tooth. Studies
have indicated that GP is beneficial as a diagnostic adjunct
and can be precise within 3 mm from the lesion. A medium-
sized cone (size 25–40) has been found satisfactory due to
its stiffness and ease of placement.[30]
Manual dynamic irrigation
GP points are used for manual agitation of irrigants in the
root canal to improve the cleansing ability of debriding and
disinfecting solutions to remove the smear layer.
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Vishwanath and Rao: Review of gutta-percha
Temporization
The base plate and temporary stopping GP are used for
this purpose after intra coronal tooth preparation and for
double seal during endodontic interappointment periods.
However, zinc oxide eugenol cements provide a better
seal than GP. Hence GP for this purpose should be used
discretely.[31]
Assessment of intracoronal tooth preparation
Assessment of intracoronal tooth preparation was used to
check undercuts in tooth preparation requiring indirect
intracoronal restorations.
Markers for orthodontic and prosthetic
implant placement
The use of guides for radiographic evaluation and surgical
placement of dental implants can improve the final
outcome of treatment for patients receiving implants. To
aid in the determination of the ideal site for the implant,
guides with markers are useful. A material to be used as a
guide during a computed tomography scan, should contain
no metal to eliminate the possibility of scatter. Since GP
fulfills this criterion, possesses radiopacity and can be
formed to a desired shape, it is the material of choice for
this purpose.[32]
CONCLUSION
It can be concluded that the availability, ease of
manipulation, chemical inertness, and cost effectiveness of
GP along with newer techniques which are easy to adapt
in clinical use have made this material indispensable in the
field of endodontics.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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