Endodontic materials and bleaching systems

Dent 305

Endodontics
Is

concerned with the morphology, physiology and pathology of the dental pulp and periradicular tissue Dental materials maybe used to perform pulp capping, intra-canal cleaning and obturation Why do root canal treatment:
Clean canals Apical seal Coronal seal

Vital pulp capping

Causes

of pulp exposure:

Caries During cavity preparation Trauma

Two

procedures:
Reference: Introduction to dental materials
4

Indirect capping Direct capping

Indirect pulp capping

Criteria

for applying this procedure and ensuring success:

No signs of bleeding from the pulp A layer of discolored dentine is left to avoid exposing pulpal tissue. Should be caries free Infection should be removed and not allowed to return by using antibacterial liner A good seal should be attained to prevent further ingress of bacteria
Reference: Introduction to dental materials
5

Indirect pulp treatment in a permanent molar: case report of 4-year follow-up. J. Appl. Oral Sci. vol.17 no.1 Bauru Jan./Feb. 2009
6

Continue,
Material

used for indirect pulp capping:

Calcium hydroxide (most popular):
High

pH antibacterial

Zinc-oxide eugenol Bonding agents (acid etching near pulp?)

Reference: Introduction to dental materials

Direct capping
Pulp

exposure occurred due to cavity preparation not caries Objective:

Dressing of exposed pulp Wall-off bacteria Stimulate calcific barrier formation over exposed areas Reference: Introduction to Maintain pulp vitality dental materials
8

Direct capping

Continue,
Pulp

capping materials should:

Be able to induce hard tissue formation No adverse effect Protect pulp from ingress of bacteria
Materials

used:

Calcium hydroxide (causes a layer of necrosis (1-1.5 mm thick) then calcific layer forms, minerals derived from pulp fluid) Dentine bonding agents: etching? Conflicting results depending on bonding agent type. Homeostasis is always important (1% Na hypochlorite)
10

Failure of pulp capping

Chronic

of pulp Extra-pulpal blood clot (prevent contact between cement and healthy pulpal tissue Restoration failure

inflammation

Reference: Introduction to dental materials

11

Irrigants and lubricants

Purpose:

Disinfect Remove debris

Ideal

properties:

Able to dissolve and disturb debris Non toxic Low surface tension Able to lubricate Able to sterilize Able to remove smear layer Reference: Applied dental
materials
12

Available irrigants (Table 31.1)

Reference: applied dental materials

The

best irrigant: sodium hypochlorite 210% Disadvantage: irritant material if in contact with living tissue Alternative if cannot be used: chlorhexidine gluconate 0.2% EDTA (ethylene diamine tetra acetic acid): maybe used as a lubricant
13

Intracanal medicaments
Paramonochlorophenol

(PMCP): no clinical indication for its use. Acts as a disinfectant Non-setting calcium hydroxide: high pH. Induces closure of apex (in immature teeth) and arrests root resorption Poly-antimicrobial pasts: mixture of steroids, tetracycline, sulphonamide
Reference: Applied dental materials
14

Non setting calcium hydroxide

15

Obturating materials
Historical

material:

Silver: corrosion, cannot be adapted well, hard to retrieve Amalgam: technically hard, retreatment is hard Medicated pastes: antibacterial
Paraformaldehyde

based: sets hard, toxic Iodoform based: resorbable

Contemporary

material:

Gutta percha Polyester resin

16

Obturating materials
Gutta

percha (GP) Composition:

Gutta percha rubber Zinc oxide as a filler Metal salts for radiopacity Wax or resin as plasticizer Antioxidants
Reference: Applied dental materials
17

Gutta percha
Handling

characteristics and properties:

Thermoplastic material softens at 60-65C and melts at 100C Oxidizes upon exposure to light and hardens Dissolved in chloroform Maybe disinfected by Na Hypochlorite Solvents such as acetone may cause it to swell then as the solvent evaporates GP shrinks No chemical bond with dentine

18

GP cones for cold packing

19

Application systems
Cold

packing (-phase GP): packing (-phase GP):

GP points (cold lateral condensation technique)

Thermal

Softening a material prior to insertion Heat application on GP after insertion then condensation Available systems: Thermafil (plastic carrier), Obtura (injection gun) Heat maybe applied using a rotary instrument, clockwise rotation next to GP in canal
Reference: Applied dental materials

20

Thermafil system

Obtura
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Obturating material continue,

Polyester

resin: based on thermoplastic synthetic polyester, barium sulphate, bismuth chlorate, bioactive glass (claimed to release calcium and phosphate inducing bone growth). This material is available for cold and hot applications.
Reference: Applied dental materials
22

Root canal sealants

Ideal properties:
Easy to use Good seal Free of air bubbles, homogenous when mixed Flow to thin film thickness Insoluble Biocompatible Radiopaque slow setting time

Function of the sealer:

To fill spaces between GP points Lubricant during obturation and fill irregularities in canal
Reference: Applied dental materials
23

Sealers

Gap between GP and root dentine

Gutta percha with sealer

24

Materials used as sealers

Zinc

oxide eugenol Resins Calcium hydroxide cements (sealapex) Glass ionomer cements Polydimethyl siloxane

25

Zinc oxide-eugenol-based cements

Three

formulations available:

Rickets (silver caused discoloration): 15 minute working time, good flow, but has thick film Grossman (contains barium for radiopacity instead of silver): 1 hour working time, good flow, lower solubility Tubliseal (paste-paste system to produce smooth mix): low film thickness, good flow, 20 minutes working time

26

27

Calcium hydroxide-containing cements

2

paste system, base and catalyst Long working time Antibacterial Biocompatible Can induce hard tissue formation Disadvantage: high solubility
Reference: Introduction to dental materials
28

29

Resins
System
AH

Reference: Applied dental materials + introduction to dental materials

available:

Commercial systems:
plus, 2 paste system: (long working time, better flow & film thickness, low solubility), based on previous product Ah 26 (released formaldehyde) ADSEAL Excellent : biocompatibility, Easy to dispense and mix, insoluble in tissue fluids

Problem:

silver content, shrinkage (depends on the product) Newer products maybe silver free with minimal shrinkage

30

Products available

31

Glass ionomer sealants

New

formulation have filler sizes < 25 m to improve handling and add radiopacity Advantages:
Bonds to enamel and dentine Low shrinkage
Disadvantages:

Short working time Difficulty in re-treatment

Reference: Introduction to dental materials
32

Polydimethyl siloxane
Composition:

Polydimethyl siloxane Paraffin oil Silicon oil Zirconium dioxide

Advantages:

insoluble, dimensionally stable, biocompatible Disadvantages: dose not bond o dentine, no antibacterial ability Reference: Introduction to
dental materials
33

Clinical aspects of root canal materials

Biocompatibility:

GP: highly biocompatible ZnO/eugenol: induce inflammation due to eugenol Resin systems: once set, low toxicity Calcium hydroxide: biocompatible, induces cementum formation

34

Continue,
Sealing

properties: properties:

antibacterial abilities physical apical seal

Physical

Working time Setting time Film thickness Solubility Dimensional stability

35

Material for root canal repair and peri-radicular surgery

MTA:

Mineral trioxide aggregate, it is highly alkaline, sets when exposed to water. When exposed to water, setting reaction starts, material remains plastic for some time which facilitates insertion for repair or root end filling material. Final setting occurs when the material crystallizes to form a hard mass with slight expansion Characteristics: induces cementogenesis, antimicrobial, biocompatible
Reference: Applied dental materials
36

37

Post and core systems

To

restore endodontically treated-badly broken don teeth. Post system provides support and retention for the coronal restoration Desirable properties:
Maximum retention with minimal preparation Aesthetically acceptable Post is retrievable Post can transfer stress to remaining tooth structure Reference: Introduction to
dental materials

38

39

Types of post systems

Prefabricated

(core is made from composite, amalgam, GIC, etc.):

Metal posts Fiber reinforced resin posts Ceramic posts: esthetic, strong, tough, rely on mechanical retention

Cast

posts
Reference: Introduction to dental materials
40

Prefabricated posts
Metal

posts made from stainless steel, nickel-chromium, titanium Variety of designs:

None-threaded parallel sided None-threaded tapered post Threaded tapered posts
Requirements

needed in a post?
Reference: Introduction to dental materials
41

Fiber reinforced resin post

Two

types:

Carbon fiber reinforced (black, unaesthetic) Glass fiber reinforced

These

posts may allow even stress distribution and reduce chance of tooth fracture. How?
Reference: Introduction to dental materials
42

Teeth bleaching
How

bleaching works: bleaching agent (hydrogen peroxide or nonperoxide agents) penetrate enamel and reach dentine then oxidizes pigments and lightens tooth color. This action is enhanced by low intensity heat or high intensity light.
Reference: Dental materials, clinical applications for dental hygienists etc.

43

BEFORE

44

Composition
Hydrogen

peroxide, carbamide peroxide, urea peroxide Non-hydrogen peroxide system containing:

Sodium chloride Oxygen Natrium fluoride
Additives

such as potassium nitrate and fluoride to reduce sensitivity

45

Types of stains
Intrinsic

(medication, trauma, disease conditions during or after tooth development) Extrinsic: coffee, tea, tobacco Combination

46

47

In-office bleaching
Bleaching

of vital teeth:

35% hydrogen peroxide liquid + heat: time consuming for multiple teeth and technique sensitive Powder and liquid system: hydrogen peroxide liquid + powder containing light/ chemical activators 35% carbamide peroxide gel system: better control than liquid system
48

49

Continue,
Bleaching

of non-vital teeth: staining maybe caused due to necrotic breakdown products of the pulp, or hemoglobin from blood in the pulp.
Bleaching is done internally through the access cavity Bleaching solution: 30% hydrogen peroxide on a saturated cotton pellet in pulp chamber then activated by a heating instrument Walking bleach: sodium peroxyborate paste or gel mixed with hydrogen peroxide then placed in access cavity.

50

51

Home bleaching
Chemical

used 10-16% carbamide peroxide at a near neutral pH in a viscous gel. Composition:

Carbamide peroxide: hydrogen peroxide + urea Gel: propylene glycol or glycerin Carbopol: thickener Flavoring agents

52

Home bleaching

53

Continue,
Duration

of treatment: products:

30 minutes twice daily-overnight 2 weeks depending on results

Over-the-counter

Crest white strips worn for 30 minutes twice (5.3% hydrogen peroxide) Home bleaching products containing preformed trays or thermoplastic trays heated in water then shaped on the dental arch (10% carbamide peroxide)
54

Before and after bleaching

55

56

Side effects of bleaching

Sensitivity Irritation of the gingiva Soreness of the muscles of mastication from wearing night guards overnight Roughness of composite restoration surfaces
Contraindications

for bleaching:

Allergy to bleaching agent Patients with very sensitive teeth Patients with multiple composites who do not wish to replace them
57

Restorative considerations
Before

bleaching:

Carious teeth should be restored Leaky restorations replaced

After

bleaching:

Esthetic restorations may need to be replaced 2 weeks period is needed for teeth color to stabilize and to replace composites or veneers

58

References
Introduction

to dental materials Applied dental materials Dental materials, clinical application for dental assistants and hygienists

59