Viva Questions: Endodontic Materials

Topic 1: Irrigants and Lubricants

Q1: What is the purpose of endodontic Irrigants?
A: The purpose of endodontic irrigants is to flush the debris from preparation of the root
canal out of the prepared area, disturb debris in the canal, and disinfect the canal.

Q2: What are the properties of an ideal irrigants?

A: According to Walton & Toribinejad (2002), an ideal irrigant should be able to
dissolve/disrupt tissue and debris in the canal, be non-toxic, have low surface tension (to
allow penetration into inaccessible areas), be able to lubricate instruments in the canal,
be able to sterilize (or at worst disinfect) the canal system, and remove the smeared layer
of preparation debris from the canal walls.

Q3: Which irrigant is the most effective among the currently available materials?
A: Sodium hypochlorite is the most effective among the currently available materials.

Q4: What is the concentration of sodium hypochlorite usually used in endodontic

treatment?
A: Sodium hypochlorite is usually used at a concentration of between 2 and 10%.

Q5: What are the disadvantages of using sodium hypochlorite as an irrigant?

A: One of the disadvantages of using sodium hypochlorite is that it is a tissue irritant
resulting in ulceration of the oral and oesophageal mucosa if it is allowed into the mouth
and an intense and extremely painful inflammatory response if it is expressed out of the
tooth into the bone around the tooth.
Q6: How can leaching of sodium hypochlorite be prevented?
A: Leaching into the mouth is prevented by using a rubber dam to isolate the tooth from
the oral environment.
Q7: When should sodium hypochorite not be used as an irrigant?
A: Hypochlorite should NOT be used as an irrigant when using a rubber dam to isolate the
tooth from the oral environment is not achievable,
either as a consequence of loss of coronal tooth structure or where it may not be possible
to confine the irrigant within a tooth;
for example, where the apex of a tooth has not fully formed at the time of pulp death or
where the clinician is aware that there has been internal damage within the structure of
the root resulting in a perforation through the side of the root through which irrigant
could leak.

Q8: What is the most appropriate alternative to sodium hypochlorite as an irrigant in

certain circumstances?
A: The most appropriate alternative to sodium hypochlorite as an irrigant in certain
circumstances is chlorhexidine gluconate in a 0.2% solution.

Q9: How do EDTA gel preparations act as custom lubricants?

A: EDTA gel preparations act as custom lubricants by lubricating the passage of
instruments into the root canal and softening the walls of the canal, facilitating the
negotiation of canals where there has been internal mineralization of the canal system

Topic 2: Intra-canal medicaments

Q1. What is the basis for using intra-canal medicaments?

Ans: The basis for using intra-canal medicaments is controversial, and there is little
evidence for their benefit unless there are problems with obtaining pulpal anesthesia or
attempting to induce formation of the root apex or arrest root resorption.

Q2. How effective is paramonochlorophenol (PMCP) as a disinfectant in the root canal

system?
Ans: PMCP is a disinfectant that has been advocated to reduce the risk of recurrent
infection of the root canal system between visits, but its effectiveness is very short-lived
within root canals as it is denatured in the presence of calcium.

Q3. What is non-setting calcium hydroxide paste and how is it used in endodontics?
Ans: Non-setting calcium hydroxide paste has a high pH and potent antimicrobial action,
and it has been shown to promote closure of the root apex in teeth where loss of vitality
has occurred. Its routine use as a medicament between visits during endodontics is
unclear, but it can be left within the tooth for long periods of time when trying to induce
apex closure or arrest root resorption.

Q4. What is poly-antimicrobial paste and when is it used in endodontics?

Ans: Poly-antimicrobial paste is a proprietary paste containing a mixture of corticosteroid,
sulphonamide, and tetracycline. It is used during the management of "hot pulps" to reduce
pulpal inflammation and facilitate access at the next visit. Its effectiveness lasts for 5 to 7
days, so it should not be left in the pulp chamber for any longer
Topic 3: Obturation materials
Q1: What is the objective of contemporary canal preparation techniques?
Ans: The objective of contemporary canal preparation techniques is to clean and shape
the root canal space to remove bacteria and infected debris and prepare the space for
obturation.

Q2: Why do contemporary obturation materials need to be plastic during placement?

Ans: Contemporary obturation materials need to be plastic during placement to allow
them to be moulded to the canal form.

31.5 Historical materials

Q3: What were silver points used for in endodontics?

Ans: Silver points were used as obturation materials in endodontics. They were thought to
match the canal taper and were sealed into place with an appropriate sealant.

Q4: Why is the fundamental principle behind the use of silver points flawed?
Ans: The fundamental principle behind the use of silver points is flawed because the
anatomy of most root canals is far too convoluted to allow for a seal to be developed by
machining the root dentine in this way. Furthermore, the silver points underwent
corrosive breakdown within the canal system resulting in the breakdown of the seal.

Q5: What is the drawback of using a paraformaldehyde paste as a root filling material?
Ans: The paraformaldehyde paste sets hard to produce a material that is very difficult to
remove, making the use of the root canal for a post difficult and retreatment of the
endodontic lesion if required very complex. Furthermore, if any of the material was
expressed beyond the apex of the tooth, it is highly toxic to tissues causing lingering pain
in bone and permanent dysesthesia or anaesthesia of nerve tissue.

Q6: What is the drawback of using iodoform paste as a root filling material in permanent
teeth?
Ans: The drawback of using iodoform paste as a root filling material in permanent teeth is
that it can result in an empty canal in the permanent dentition as it is resorbable.
31.6 Contemporary materials
Sealants

Q1. What is the contemporary approach to obturating the root canal space?
Ans: The contemporary approach to obturating the root canal space is to use a malleable
bulk fill material in association with a thin sealant that is used to fill the spaces around
the bulk fill material and to refine adaptation of the materials, particularly to the walls of
the prepared root canal.

Q2. What is the purpose of a sealant in root canal treatment?

Ans: The purpose of a sealant in root canal treatment is to fill the spaces between
increments of the bulk fill material and to improve the quality of adaptation of the
composite of sealant and bulk fill to the walls of the root canal to help maintain the seal
around the root filling.

Q3. What are the ideal properties of a sealant?

Ans: The ideal properties of a sealant, as suggested by Grossman et al., include

 tissue tolerance,
 insolubility in tissue fluids,
 dimensional stability during setting,
 hermetic sealing ability, radiopacity,
 bacteriostatic or bactericidal properties,
 good adhesion to the canal wall when set,
 ease of mixing, non-staining, slow setting time,
 and easy removal if necessary (may need to be soluble in a solvent to facilitate
removal).

Q4. What are sealants in root canal treatment?

Ans: Sealants in root canal treatment are essentially thin pastes that can be both
introduced into the canal system and used to coat the bulk fill material.

Q5. What are the two most commonly used materials for sealants in root canal treatment?
Ans: The two most commonly used materials for sealants in root canal treatment are
either zinc oxide and eugenol or calcium hydroxide-based.
Q6. What is Grossman's formulation of modified zinc oxide and eugenol cements?
Ans: Grossman's formulation of modified zinc oxide and eugenol cements is Powder: 42
parts zinc oxide, 27 parts stabellite resin, 15 parts bismuth sub carbonate, 15 parts barium
sulphate, and 1-part sodium borate; Liquid: eugenol.

Q7. What is the setting time of Grossman's formulation?

Ans: Grossman's formulation has an exceptionally long setting time, up to 2 months.

Q8. What is the resin-based product that is commercially available for use with gutta-
percha?
Ans: The resin-based product that is commercially available for use with gutta-percha is
based on the epoxy resins, with a formulation of Powder: bismuth oxide 60%,
hexamethylenetramine 25%, silver 10%, and titanium dioxide 5%; Liquid: epoxy bisphenol-
resin.

Q9. What are the advantages and disadvantages of using the resin-based product for root
canal treatment?
Ans: The advantages of using the resin-based product for root canal treatment include a
good seal and a marked antimicrobial action. However, the silver-containing formulation is
associated with staining of the dentine, and there is some release of formaldehyde from
the material once set, which is tissue toxic.

Q10. What are the materials used as sealants with the polyester bulk fill materials?
Ans: Resins and dentine bonding agents are used as sealants with the polyester bulk fill
materials.

Bulk filling materials

Q1. What is the purpose of bulk filling materials in root canal therapy?

Ans. The purpose of bulk filling materials is to provide an inert mass that can be used to
fill the large defect which comprises the prepared root canal.

Q2. What are the key characteristics that bulk filling materials must possess?

Ans. Bulk filling materials must be malleable during the insertion phase and must be
dimensionally stable.
Q3. What is gutta percha and what is it derived from?

Ans. Gutta percha is a widely used bulk filling material. It is derived from latex as an
isomer of rubber known as trans-polyisoprene.

Q4. What are the two crystalline forms of gutta percha, and which one is more commonly
used with cold packing techniques?

Ans. The two crystalline forms of gutta percha are α and β. The β form is more commonly
used with cold packing techniques, while the α form is mainly used in thermoplastic
manipulation techniques.

Q5. What components are typically found in gutta percha used in dentistry?

Ans. Gutta percha used in dentistry typically comprises between 19 and 22% trans-
polyisoprene, zinc oxide (between 60 and 75%), and a variety of other components
including colouring agents, resins, waxes, antioxidants, and metallic salts.

Q6. What are the advantages of Resilon® over traditional gutta percha?

Ans. Resilon® is a commercially available material based on a thermoplastic synthetic

polyester, barium sulphate, bismuth chlorate, and a bioactive glass. It is claimed that the
bioactive glass releases calcium and phosphate ions from its surface on exposure to bodily
fluids, stimulating bone growth. Resilon® offers advantages over traditional gutta percha,
such as better sealing and reduced shrinkage.

Q7. What is bioactive glass, and how does it contribute to the functionality of Resilon®?

Ans. Bioactive glass is a component of Resilon® that releases calcium and phosphate ions
from its surface on exposure to bodily fluids, stimulating bone growth.

Q8. In what forms is Resilon® available for use in root canal therapy?

Ans. Resilon® is available in both tapered and pelleted forms for use with either cold or
thermoplastic filling techniques.
Materials for root canal repair and peri-radicular surgery

Q1: What materials have been used for dental repairs in the past?
Ans: Dental amalgam, zinc oxide and modified zinc oxide pastes, and glass ionomer
cements have been used for dental repairs in the past.

Q2: What is Mineral trioxide aggregate (MTA)?

Ans: Mineral trioxide aggregate (MTA) is a material used for dental repairs that comprises
tricalcium silicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite,
calcium sulfate, and bismuth oxide.

Q3: How is MTA made?

Ans: MTA is made by fusing together the constituents and grinding them to form particles
of clinker.

Q4: How does MTA set?

Ans: The setting reaction of MTA involves an initial hydration phase with wetting of the
particle surfaces with partial dissolution of the calcium sulfate.
Crystals of hydrated calcium aluminium sulfate hydroxide (ettringite) form on the surface
of the clinker particles through interaction with the tricalcium aluminate.
There is then a delay in the setting reaction during which the material is plastic and can
be inserted into defects for repair.
The final phase of setting is characterized by growth of calcium silicate hydrate crystals
along with the ettringite crystals between the clinker particles, such that the material
forms a rigid mass.

Q5: What are the properties of set MTA?

Ans: In its set condition, MTA is biocompatible, and can provide a good seal at the root-
material interface. Owing to its alkalinity, it is also antimicrobial.

Q6: What is the potential risk associated with excessive expansion during setting of MTA?
Ans: Excessive expansion during the setting of MTA may potentially result in root fracture,
although it may also improve the seal of the canals.
Clinical Handling
Q1: What is contemporary thinking on canal preparation?
Ans: Contemporary thinking involves using a combination of hand or mechanical
instrumentation along with an irrigant to clean, shape, and disinfect the canal system
before filling it with an inert material.

Q2: What is lateral condensation?

Ans: Lateral condensation is a technique used for three-dimensional obturation, which
involves inserting a gutta percha cone of matching taper and size to the instrument used
to create the apical stop. The cone is coated thinly in the sealant of choice and inserted
to the working length in the canal. A spreader is then used to squash the gutta percha
against the sides of the root canal, creating a space in the canal into which an accessory
gutta percha cone is inserted, once again coated in a thin film of sealant. This lateral
condensation process continues until the canal is full of a homogenous mixture of gutta
percha and sealant.

Q3: What is thermomechanical compaction?

Ans: Thermomechanical compaction is a thermal packing method that uses a tapered
instrument, which is shaped to have an action like an Archimedean screw. The instrument
is inserted adjacent to gutta percha points in the canal and then is driven at relatively
high speed in a clockwise direction. The action of the steel instrument causes frictional
heating of the gutta percha which is then driven down into the canal and forced sideways
by the action of the compactor.

Q4: What are the potential disadvantages of thermal techniques for gutta percha packing?
Ans: The potential disadvantages of thermal techniques for gutta percha packing is that
the gutta percha will undergo dimensional change as it cools, which can impair the quality
of the seal that can be achieved. Therefore, the forces that are used to press the softened
material into the canal must be applied for the duration of the cooling period to overcome
thermal shrinkage.