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Root End filling Materials

Root End filling Materials. CONTENTS. INTRODUCTION IDEAL REQUIREMENTS OF A ROOT END FILLING MATERIAL VARIOUS ROOT END FILLING MATERIALS MISCELLANEOUS MATERIALS CONCLUSION REFERENCES. INTRODUCTION.

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Root End filling Materials

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  1. Root End filling Materials

  2. CONTENTS • INTRODUCTION • IDEAL REQUIREMENTS OF A ROOT END FILLING MATERIAL • VARIOUS ROOT END FILLING MATERIALS • MISCELLANEOUS MATERIALS • CONCLUSION • REFERENCES

  3. INTRODUCTION • The main objective of all endodontic procedures is to obtain a hermetic seal between the periodontium and root canal system, so that no bacteria or bacterial by products can enter or leave from the canal. • Apical resection or apicectomy followed by root end (retrograde) filling is a common treatment when conventional root canal treatment has failed.

  4. Throughout the dental history, a wide variety of root end filling materials have been evaluated for biocompatibility, adhesiveness, dimensional stability, solubility, leakage etc in an attempt to identify the ideal material. • A thorough understanding of the available materials is very important for the success of the treatment.

  5. IDEAL REQUIREMENTS OF ROOT END FILLING MATERIALS • They should be biocompatible to periapical tissues • Should be insoluble in tissue fluid • They should adhere to the tooth (Adhesion) • Should be bactericidal or bacteriostatic

  6. Dimensionally stable • Readily available and easy to handle • Non corrosive, should not stain teeth or periradicular tissue • Radiopaque • Electrochemically inactive • Promote cementogenesis

  7. MATERIALS

  8. AMALGAM

  9. It is the most extensively used retrofilling material from past seven decades. • Farrar (1884) first reported amalgam as a root end filling material • Later Rhein (1897), Faulhaber and Newmann (1912), Happels (1914) and Garvin (1919) supported to the use of amalgam as root end filling materials.

  10. Concerns in the use of amalgam as a root end filling can be categorized under the following factors • Type of amalgam (high copper versus conventional, zinc versus non zinc). • Leakage of amalgam root end fillings • Tissue compatibility

  11. Preparation and manipulation of the amalgam. • Electric potential – galvanic currents, corrosion and degradation • Pigmentation or argaria of the surrounding tissue.

  12. Type of Amalgam (High Copper Vs Low Copper, Zinc Vs Non Zinc) In conventional alloy: 2 phases is comparatively weak, corrosion prone For the short comings of 2 phase the high copper content amalgam were developed

  13. Ag3Sn + Cu + Hg = Ag3Sn + Ag2 Hg3 + Cu6Sn5 1  • Copper replaces some of the silver in this alloys react to form a copper – tin compound (Cu6 Sn5)  phase which eliminates the weak, corrosion prone 2 phase. • High levels of copper increases the resistance to marginal breakdown, increases dimensional stability and less susceptible to corrosion.

  14. Zinc Vs Non-zinc • Effect of moisture on zinc alloys is well established, zinc causes electrolytic disassociation of water into hydrogen and oxygen. • The presence of hydrogen gas causes internal pressure great enough to expand the amalgam from within, which can cause root end expansion, amalgam or root fracture and leakage.

  15. Therefore from all the above: high copper zinc free amalgam is preferred as root end filling material.

  16. LEAKAGE OF AMALGAM • Multiple techniques have been advocated to determine the apical leakage or marginal adaptation of root end amalgam fillings. These include India Ink, silver nitrate, methylene blue, aniline dye, fluorescent dye, scanning electron microscopy bacterial penetration, radioisotopes etc.

  17. The conclusion drawn from these studies was root end amalgam leak minimally adequate at first. • The marginal adaptation as well as sealing improves as amalgam ages ,due to formation of corrosion products.

  18. The use of amalgam bond, 4-META bonding agent with amalgam significantly reduces the microleakage of amalgam retrofillings. • 4-META monomer contains both hydrophobic and hydrophilic ends, the hydrophobic end attached to amalgam and the hydrophilic end helps bonding to dentin. • This increases dentin sealing and improves resistance but increase in retention form is not significant.

  19. TISSUE COMPATIBILITY • Various studies demonstrated that freshly mixed conventional silver amalgam are very cytotoxic due to the unreacted mercury, cytotoxicity decreases rapidly as the material hardens (All unreacted mercury is consumed within 2hours of set). • Amalgam containing zinc have more lasting cytotoxicity compared to non zinc amalgam this is due to the continued release of the ionic species.

  20. Various studies identified the cytotoxicity of both low and high copper content alloys. However, the cytotoxicity decreases with ageing possibly due to the surface oxidation and continued amalgamation.

  21. MATERIAL PREPARATION AND MANIPULATION • Preparation and manipulation of the amalgam alloy at the time of placement is crucial in determining the strength, marginal adaptation, degree of porosity and surface smoothness.

  22. Key points to consider when alloys placed intraorally • Amalgam squeezed of their excess mercury have a decrease in their final strength. The Eames 1:1 ratio technique are preferable. • Amalgams are more closely adapted to the confines of the cavity during mechanical rather than hand condensation, however the use of mechanical condenser may be limited.

  23. Optimal structure for the amalgam margins can be obtained by overfilling, burnishing the margin and removal of excess by carving. Burnishing decreases micro porosity, improves marginal adaptation and seal. • Root end amalgams placed at the time of surgery cannot be polished, the unpolished amalgam surfaces have been shown to release greater amounts of mercury and silver, polishing decreases the tendency for corrosion and improves the marginal seal.

  24. ELECTRIC POTENTIALS – GALVANIC CURRENTS

  25. ELECTRIC POTENTIALS – GALVANIC CURRENTS • Placement of root end amalgam in a tooth which has a metallic post or crown restoration could create a galvanic couple, which has the potential to generate significant amounts of electric currents.

  26. Currents in excess of 50µA have been shown to cause tissue necrosis, more over increased production of galvanic currents leads to electro chemical corrosion and releases significant amount of zinc in to the periradicular tissue. • Therefore it is better to avoid or minimize the possibility of this potential problem.

  27. TISSUE STAINING – ARGYRIA

  28. TISSUE STAINING – ARGYRIA Staining of hard and soft tissue subsequent to root end amalgam filling could be due to the following : • Amalgam scattered in the surgical site during placement of the root end filling or due to removal of failing root end amalgam. • Fractured or loosened amalgam root end fills • Galvanism and electrochemical corrosion

  29. PREVENTION • Control of amalgam particles in the surgical site during amalgam placement • Efficient irrigation and aspiration of the surgical area are essential during removal of previously placed amalgam. • Fracture or loosening of amalgam root end fills can be avoid by proper placement with appropriate bulk in the thickness and by giving mechanical retention in the root end.

  30. GUIDELINES FOR AMALGAM USAGE AS A ROOT END FILLING • Although amalgam is not the ideal material, the following concepts should be considered when choosing amalgam as the root end filling material. • Control of moisture in the surgical site is essential • High copper alloys are the materials of choice at present • Varnish or dentin bonding agents must be used prior to alloy placement

  31. When moisture cannot be controlled zinc free alloys should be considered • Create a smooth surface of the finished alloy • Prevent the dispersion of alloy particles in the surgical site • Keep the alloy as small as possible in diameter with enough thickness to resists fracture

  32. GALLIUM ALLOYS • the toxic effect of mercury led the researchers to think of alternatives. • Gallium alloy was first suggested by Putt Kammer in 1928 Properties • It has the property of wetting many materials including tooth structure. • Alloy of gallium are mixed and condensed as silver amalgam using almost the same instruments

  33. Compressive and tensile strength increases with time comparable with silver amalgam. • Expand after mixing therefore provides better marginal seal • Stability and corrosion resistance equal or even greater than silver amalgam.

  34. Composition • Alloy Liquid • Silver Gallium • Tin Iridium • Copper • Palladium

  35. Reaction • AgSn + Ga  AgGa + Sn • Alloy and liquid are mixed as usual • Structure of gallium resembles that of silver amalgam • Reaction between silver tin particles and liquid gallium involves the formation of silver gallium and pure tin phase. • After mixing alloy tends to stick, therefore more difficult to handle.

  36. Disadvantages • Gallium alloy shows surface roughness and marginal discoloration • Since these alloys are sticky manipulation is difficult • Cost is approximately 16 times more than that of silver amalgam.

  37. GOLD FOIL • First reports on its use as a root end filling material is attributed to Schuster in 1913 and Lyons in 1920. • Reports in 1960s and 1980s continued to recommend its use because of perfect marginal adaptation, surface smoothness and tissue biocompatibility. • Gold foil was least toxic compared to IRM, composite resin, amalgam, and GIC.

  38. Leakage studies in root end preparation have indicated minimal or no leakage. • Although it possesses favorable material properties, the routine use of gold foil as a root end filling material does not appear practical because of the need to establish moisture free environment, the need for careful placement and finishing. However, its use in isolated cases can be justified.

  39. SILVER CONES

  40. SILVER CONES • Silver cones have been used to obturate the root canals since the early 1930s. • Their ability to seal the root canal three dimensionally has been challenged as the circular, tapered natured of the core provides only a central core material which is surrounded by a sea of root canal sealer.

  41. There are several techniques recommended by different people to root end fill with silver cone. • Summers in 1946 presented a reverse canal instrumentation. The cone was inserted into the canal at the resected root end and cutoff, smoothed or burnished to confirm the resected root surface. • This technique was specially recommended when post-core crown was present. The silver cone extend from the resected root end to the apical extent of the post.

  42. TRICE recommended a fissure bur to cut the previously placed silver cones, followed by smoothening the surface with the round bur. • GUIDELINES CONCERNING SILVER CONES ROOT END FILLS • Silver cones cannot 3 dimensionally obturate the root canal space, especially in areas coronal to the apex which are likely to be exposed during resection. • Resection of root end containing silver cone will open voids between the cone and dentin wall

  43. Resection of silver cone, increase corrosive potential over long periods of time, the corrosive products may be highly cytotoxic. • Silver cones cannot be burnished to perfect apical seal

  44. Ideally teeth containing silver cones, requiring surgery should be non surgically retreated with well condensed gutta percha and root canal sealer. • A root end fill is indicated in all cases of root end resection when silver cone is present.

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