Bioactive Materials in Endodontics PDF

BIOACTIVE MATERIALS DR. CLAUDINE LAGMAN BIOACTIVITY “The ability of a material to elicit a response in a living tissue” D Grotra, C V Subbarao: Bioactive materials in endodontics. recent research in science and technology 2012:4(6); 25-27 “Bioactive material must be able to elicit a biological respo...

BIOACTIVE MATERIALS DR. CLAUDINE LAGMAN BIOACTIVITY “The ability of a material to elicit a response in a living tissue” D Grotra, C V Subbarao: Bioactive materials in endodontics. recent research in science and technology 2012:4(6); 25-27 “Bioactive material must be able to elicit a biological response at the interface and induce the formation of a bond between tissue and the material” MG Gandolfi , P Taddei, A Tinti and C Prati : Apatite-forming ability (bioactivity) of ProRoot MTA., Int Endod J 2010 43(10); 917–929 The ideal properties of bioactive material bactericidal bacteriostatic sterile stimulate reparative dentine formation maintain pulp vitality. Uses of BioActive Materials Øpulp capping material ØUsed for permanent restorations ØUsed for dentinal tubule occlusion. ØPrevents dentinal hypersensitivity Øhelps in regeneration of bone tissue. Øpromotes tooth remineralization Various BIO Active Materials Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø calcium hydroxide, mineral trioxide aggregate (MTA), calciumenriched mixture (CEM), Biodentine Inert material (isobutyl cyanoacrylate and tricalcium phosphate ceramic), ActiveTM BioACTIVE restorative material, Pulpdent (composite resin that are more bioactive and release more fluoride than glass ionomers), MTYA1-Ca filler, tetracalcium phosphate (TTCP), sol-gel-derived bioactive glass (BAG) ceramic containing silver ions (Ag-BG), calcium phosphate, novel endodontic cement (NEC), endo sequence root repair material. MTA Mineral Trioxide Aggregate Mineral trioxide aggregate (MTA) was developed for use as a dental root repair material by Dr. Mahmoud Torabinejad, (MTA) It is the most commonly recommended material for sealing communications between the root canal system and the periodontium MTA COMPOSITION MTA is comprised primarily of 75 % Portland cement 20 % bismuth oxide (Bi2O3) 5 % calcium sulfate dihydrate or gypsum (CaSO4 · 2H2O) *Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater 2008;24: 149–64. MTA COMPOSITION Additional minor trace elements may also be present *Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater 2008;24: 149–64. ASSIGNMENT: Why Bismuth Oxide and Gympsum are added? There are two types of MTA 1. Gray 2. White Setting time: about hours 2 and Antimicrobial Biocompatible MTA PROPERTIES 45 min Radio opaque Nonresorbable Characteristics of MTA Set in the presence of moisture 10.2, after 3 pH: initially- hours- 12.5 (remains constant) Low or no solubility Minimal leakage Compressive strength develops over a period of 28days *more than 133MPa Biocompatibility MTA is a biocompatible material with good sealing ability generate little or no inflammatory response in periradicular tissues Ca & P are the encourage the formation of fibrous connective tissue formation of cementum covering the entire root end main ions present in this material, which are the components of dental tissues Sealing ability MTA expands during setting reaction excellent sealing ability In presence of moisture sealing ability of MTA is increased Moistened cotton pellet should be placed in contact with MTA before placement of the permanent restoration Setting Time MTA powder consists of fine hydrophilic particles. Hydration of MTA powder results in a colloidal gel that solidifies to a hard structure in ~ 4 hrs which has a long setting time. MTA has long shrinkage. setting time with less Torabinejad M, Hong CU, McDonald F, et al. Physical and chemical properties of a new root-end filling material. J Endod 1995;21:34–53 Solubility Lack of solubility is an ideal characteristic of MTA as a root end filling material. Compressive Strength Is an important factor to be considered when a filling material is placed in a cavity that bears occlusal pressure. Radiopacity Bismuth oxide added for radiopacity and it is more radio opaque than its surrounding structures. Usage in some clinical cases 1. Root-end Filling after Apicoectomy 2. Internal & external root resorption & obturation 3. Lateral or furcation perforation 4. Root canal sealer 5. Apexification 6. Apexogenesis (Vital pulp) Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413 Video MTA MANIPULATION Root –end Filling after Apicoectomy Endodontic surgery followed by root end filling may at time be necessary for certain tooth where routine endodontic treatment is not possible Internal & external root resorption & obturation Lateral or furcation perforation Figure 1: (a) Pulpal floor view of furcation with internal matrix in place, (b) furcation filled with blood, (c) excess blood soaked with damp cotton pellet, (d) perforation sealed with repair material http://www.jcd.org.in/viewimage.asp?img=JConservDent_2013_16_5_462_117504_u2.jpg Apexification (Necrotic pulp) Figure 1: (a) Preoperative. (b) and (c) Working length determination. (d) MTA apical plug of 4-5mm thickness. (e) Final obturation. (f) After 8month reassessment, continuous lamina dura and consistent width of periodontal ligament space suggest healing of the periapical lesion. Boon of MTA Apexification in Young Permanent Posterior Teeth Vinod Kumar, Mohammed Zameer, Vijaya Prasad, and T. Mahantesh Department of Pediatric and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka 584103, India Apexogenesis (Vital Pulp) The process of maintaining pulp vitality during pulpal treatment to allow continued development of the entire root (apical closure occurs approximately 3 years after eruption). Procedure of pulpotomy with MTA Control the bleeding MTA placement over exposure pulp tissue by using MTA carries. Moist cotton pellet placement on MTA material allow setting the rest of cavity filled with temporary filling Next visit the temporary filling removed along cotton pellet tooth rest orated with permanent restoration. Why use MTA for pulpotomy instead of formocresol? **Formocresol has been criticized for its tissue irritant , cytotoxic and mutagenic effect. While MTA found to be ideal material with low toxic effect increased tissue regeneration properties and good clinicalresult. **An important clinical advantage of MTA over FC is less time is required for the procedure. While FC requires 3–5 minutes application before the cotton pellet is removed. **During the removal of FC-soaked cotton pellet, there is a possibility of the cotton fibers adhering to clot, resulting in reoccurrence of bleeding. This does not occur with MTA as it is applied directly without cotton pellet https://www.sciencedirect.com/science/article/pii/B9780723436959000079 MTA LIMITATIONS Ø Not used in area open to oral environment § Because of solubility in acid environment generated by bacteria, food and beverages Ø Not recommended for obturation of primary teeth - material is slowly resorbed Ø Not used with anterior teeth (discoloration) Ø Not uses as permanent filling – low compressive strength MTA DRAWBACKS Ø Ø Ø Ø discoloration potential presence of toxic elements in the material composition difficult handling characteristics long setting time *Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413 Ø high material cost Ø absence of a known solvent for this material Ø difficulty of removal after curing Ø Low compressive strength incompatible with restorative indications *Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413 BIODENTINE ž Biodentine: is the first all-in-one, biocompatible and bioactive material to use wherever dentine is damaged. Biodentin - calcium silicate based product which became commercially available in 2009 by septodont and that was specifically designed as a “ dentine replacement “ material COMPOSITION OF BIODENTINE Powder packaged in capsule(0,7g) Tricalcium silicate( main core material) Dicalcium silicate Calcium carbonate Iron oxide (shade) Zirconium oxide(radiopacity) Liquid (packaged in pipette(0,18ml) Calcium chloride(accelerator) Hydrosoluble polymer (water reducing agent, faster setting) Water MANIPULATION The powder is mixed with the liquid in a capsule in the triturator for 30 seconds 1 capsule powder: 5 drops of liquid Setting time: Approximately 12 min Advantages of Biodentine Advantages of Biodentine v For crown and root indications. v Helps in remineralization of dentine. v Preserves pulp vitality and promotes pulp healing. v Replaces natural dentine with the same mechanical properties. v Better handling and manipulation. v Reduced setting time. DENTIN SUBSTITUTE Biodentine has dentin like mechanical properties. It can be used as permanent dentine substitute (base) under composite or amalgam especially in deep carious teeth. PULP CAPPING Biodentine can be used safely and effectively as pulp capping material. Encourage pulp healing Dentin bridge formation by odontoblast stimulation Initiate early mineralization PULPOTOMY § Pulpotomy is another widely used vital pulp therapy method in which biodentine is advocated. § Preferred when the coronal pulp tissue is inflamed and a direct pulp capping is not a suitable option. § The rate of success of vital pulpotomy with biodentine is higher than MTA. Recently at the 12th congress of european academy of pediatric dentistry (EAPD) in poland, rubanenko et al. Presented their preliminary results of comparing biodentine versus formocresol as dressing agents in pulpotomized primary molars. They demonstrated a success rate of 100% for biodentine while that of formocresol was 94%. REPAIR OF PERFORATIONS Biodentine has its own unique properties that make it preferred for perforation repair either in root canal or pulp chamber floor. Due to their good adhesion to dentin surface and fast setting time. REPAIR OF RESORPTION Biocompatibility and ability to induce calciumphosphate precipitation at the interface to the periodontal tissue, calcium silicate cements play a major role in bone tissue repair APEXIFICATION biodentine can be used successfully in necrotic immature teeth. Tight bacterial seal Induction of formation of new cementum Induction of formation of new pdl Cauwels et al. Found that necrotic immature teeth can still achieve continued root development after proper regenerative endodontic treatment with biodentine. CONCLUSION Due to its major advantages and unique features as well as its ability to overcome the disadvantages of other materials, biodentine has great potential to revolutionize the different aspects of managing both primary and permanent in endodontics as well as operative dentistry. On the other hand, further studies are needed to extend the future scope of this material regarding the clinical applications.” REFERENCES biodentine active biosilicate technology scientific file, septodont, paris, France. L. Grech, B. Mallia, and J. Camilleri, “characterization of set intermediate restorative material, biodentine, bioaggregate and a prototype calcium silicate cement for use as root- end filling materials,” inter national endodontic journal,vol.46,no. 7,pp.632–641,2013 M.B.Kayahan,m.H.Nekoofar,a.Mccannetal.,“Effec to facid etching procedures on the compressive strength of 4 calcium silicate-based endodontic cements,” journal of endodontics,vol. 39,no.12,pp.1646–1648,2013. L. Grech, B. Mallia, and J. Camilleri, “investigation of the physical properties of tricalciumsilicate cement-basedroot-end filling materials,” dental materials, vol. 29, no. 2, pp. E20–e28, 2013. J. Camilleri, “investigation of biodentine as dentine replacement material,” journal of dentistry, vol.41,no.7,pp.600–610, 2013. M.E.Odabas¸,m.Bani,andr.E.Tirali,“shear bond strengths of different adhesive systems to biodentine,”the scientific world journal,vol.2013,article id 626103,5 pages, 2013