Endo Tribune Middle East & Africa Edition

ENDO tribuNE Dental tribune Middle East & Africa Edition | January-February 2016 < Page 1B silicates (MTA (Tulsa Dental)) and Bioaggregate (DiaDent) have been used in dentistry as root repair materials and for apical root illing materials. Properties of Endodontic bioceramic Materials Endodontic bioceramics are not sensitive to moisture and blood contamination and therefore are not technique sensitive (5). They are dimen- sionally stable and expand slightly on setting, making them one of the best sealing materials in dentistry (5). When set they are hard allow- ing full compaction of a inal restoration and are insoluble over time ensuring the supe- rior long-term seal. The pH when setting is above 12 due to the hydration reaction forming calcium hydroxide and later dissociation into calcium and hydroxyl ions (6). Therefore when unset the ma- terial has antibacterial prop- erties. When fully set it is bio- compatible and even bioactive. When bioceramic materials come in contact with tissue luids, they release calcium hy- droxide that can interact with phosphates in the tissue luids to form hydroxyapatite. Few clinicians realize that original MTA is a classical bioceramic material with the addition of some heavy met- als. MTA is one of the most ex- tensively researched materials in the dental ield (7,8). It has the properties of all bioceram- ics i.e. high pH when unset, biocompatible and bioactive when set and provides an ex- cellent seal over time. Howev- er, it has some disadvantages. The initial setting time is at least 3 hours. It requires mix- ing (resulting in considerable waste), it is not easy to manip- ulate, and is hard to remove. Clinically, both gray and white MTA stain dentin, presumably due to the heavy metal content of the material or the inclusion of blood pigment while setting (Fig. 1)(9,10). Finally, MTA is hard to apply in narrow canals, making the material poorly suited for use as a sealer. Efforts have been made to overcome these short- comings with new composi- tions of MTA or with additives. However, these formulations affect MTA’s physical and me- chanical characteristics. 2nd Generation bioCeramics: Endodontic Pre-Mixed bioc- eramics These products are available in North America as Endose- quence® BC Sealer™ (BC seal- er), Endosequence® Root Re- pair Material Paste™ (BC RRM Paste Syringable) and Endose- quence® Root Repair Material Putty™ (BC RRM Putty) (Bras- seler, USA Dental LLC, Savan- nah, GA). Recently, these materials have also been made available out- side North America as Total- ill® BC Sealer™, TotalFill® BC RRM™ Paste and Total- Fill® BC RRM™Putty. All three forms of bioceramic are similar in chemical com- position (calcium silicates, zir- conium oxide, tantalum oxide, calcium phosphate monoba- sic and illers), have excellent mechanical and biological properties and good handling properties. They are hydro- philic, insoluble, radiopaque, aluminum-free, high pH, and require moisture to set and harden. The working time is more than 30 minutes, and the setting time is 4 hours in nor- mal conditions, depending of the amount of moisture avail- able. In addition, Totalill® Fast Set Putty™ has recently been in- troduced into the market that has all the properties of the original putty but has a faster setting time (approximately 20 minutes). Studies on Endodontic Pre- Mixed bioceramic materials To date, more than 50 studies have been performed on Pre- mixed Endodontic Bioceramic materials. The vast majority of these studies have shown that the properties conform to those expected of a bioceram- ic material and are similar to MTA. Case report A 29 year old Caucasian female presented pointing to Tooth 11 complaining that her tooth was mobile and pus was pres- ent in her gum. Her medical history was non-contributory. Her dental history was that she had had root treatment on the Tooth 11 years previously. The tooth had become discolored about 4 years previously and bleaching with hydrogen per- oxide performed. Clinical and radiographic ex- amination revealed a sinus tract that traced to a resorptive defect in the cervical area of the tooth (Figure 1). With the patients input and consent a treatment plan was devised to perform a retreat- ment on Tooth 11 and then sur- gically remove the resorptive defect. The patient understood that due to the position of the defect that the prognosis was fair. The retreatment was initi- ated by removal of as much gutta-percha as possible and disinfecting the root canal. Bleeding was seen from the re- sorptive defect. The canal and the defect were illed with cal- cium hydroxide and the access sealed with IRM (Figure 2). Two weeks later the patient presented asymptomatic. The sinus tract had disappeared and the resorptive defect was free of active bleeding. The retreatment was continued and calcium hydroxide placed into the root canal. Since the resorptive defect was dry and accessible, it was decided to ill the resorptive defect with BC putty from an internal ap- proach (Figure 3). When the patient returned in another two weeks the sinus tract was still not present, the bioceramic was fully set and appeared to be sealing well. The root canal was completed the access cavity sealed with a bonded resin (Figure 4). At the six month and ifteen month follow-up the patient was asymptomatic. Probing was normal and sinus tract was not present. Bony ill in of the resorptive defect was seen (Figure 5). Discussion Cervical root resorption is ex- tremely dificult to treat. In most cases, it requires treat- ment from an external ap- proach because it is so dificult to get a good seal between the external surface where the re- sorptive tissue originates and the inner resorptive defect. The external approach is usu- ally very destructive to the at- tachment apparatus and some- times actually shortens the life of the tooth. The bioceramic putty is easy to manipulate and was able to low into the defect when it was free of blood. The material uses the body luids to set and its slight expansion on setting provides an excellent seal. The superior seal and bio-ac- tive nature of the bioceramic material explains the bone ill into the resorptive defect against the BC material. references (1) S.M. Best, A.E Porter, E.S Thian, J Huang. Bioceramics: Past, present and for the fu- ture. Journal of the European Ceramic Society 28 (2008) 1319-1327. (2) V.A. Dubok, BIOCERAM- ICS: YESTERDAY, TODAY, TO- MORROW, Powder Metallurgy and Metal Ceramics, Vol 39, Nos 7-8, 2000. (3) L. Hench. Bioceramics, From Concept to Clinic, J. Am. Ceram. Soc., 74 (7) 1487-510 (1991). (4)K. Hickman. Bioceramics, Internet (Overview) April 1999 (www.csa.com/discovery- guides/archives/bioceramics. php) (5) Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: a comprehensive literature re- view Part II – Leakage and bio- compatibility investigations. J Endod 2010 Feb; 36 (2): 190- 202 (6) Zhang H, Shen Y, Ruse ND, Haapasalo M. Antibacterial activity of endodontic sealers by modiied direct contact test against enterococcus faeca- lis, J of Endod, 2009: 35 (7Z)Z: 1051-5 Parirokh M, Torabine- jad M. (7) Parirokh M, Torabinejad M. Mineral Trioxide Aggre- gate: a comprehensive litera- ture review Part II – Leakage and biocompatibility investi- gations. J Endod 2010 Feb; 36 (2): 190-202. (8) Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: a comprehensive literature re- view Part I – Chemical, physi- cal and antibacterial proper- ties. J Endod 2010 Jan; 36(1): 16-17. (9) Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: a comprehensive literature re- view Part III – Clinical applica- tions, drawbacks and mecha- nisms of action. J Endod 2010 Mar; 36 (3): 400-13 (10) Belobrov I, Parashos P. Treatment of tooth discolor- ation after the use of white mineral trioxide aggregate. J Endod. 2011 Jul;37(7):1017-20. Figure 1. Clinical and radiographic view showing a sinus tract which when traced pointed to a cervical defect on the distal of tooth 11. Figure 2. The bleeding defect is seen in the cervical area at the initiation of the retreatment of the root canal. Figure 4. Access opening showing gutta-percha in the root canal and BC putty in the resorptive defect. The radiograph is the immediate post operative situa- tion. Figure 3. Resolution of the sinus tract with a dry defect internally. The defect was illed from an internal approach with BC putty. Calcium hydroxide was placed into the canal for an additional 2 weeks. Figure 5 .Clinically probing was normal and the sinus tract had disappeared. The 6 and 15 month follow up radiographs show bone ill in of the resorptive defect. 6moNthsfollowup 15moNthsfollowup Ilya Mer BDS Private Practice, Russia ilya.mer@gmail.com Martin Trope BDS, DMD Clinical Professor, USA martintrope@gmail.com Contact Information

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