Endodontic Materials in Clinical Practice

List of Contributors xi

1 Introduction: Materials Chemistry as a Means to an End(o) – The Invisible Foundation 1
Brian W. Darvell

1.1 Introduction 1

1.2 The Substrate 2

1.3 Nomenclatural Hype: ‘Bioactivity’, ‘Bioceramics’ 3

1.4 Chemical Interactions and Irrigation 6

1.5 Terminology 9

1.6 Classification of HSCs 11

1.7 Conclusion 12

References 13

2 Pulp Capping Materials for the Maintenance of Pulp Vitality 15
Phillip L. Tomson and Henry F. Duncan

2.1 Introduction 16

2.2 Maintaining Pulp Vitality 16

2.2.1 Why Maintain the Pulp? 16

2.2.2 Pulpal Irritants 16

2.2.3 Pulpal Healing After Exposure 17

2.2.4 Classifications of Pulpitis and Assessing the Inflammatory State of the Pulp 18

2.2.5 Is Pulpal Exposure a Negative Prognostic Factor? 19

2.2.6 Soft Tissue Factors Related to the Tooth 19

2.3 Clinical Procedures for Maintaining Pulp Vitality 21

2.3.1 Managing the Unexposed Pulp 21

2.3.2 Tooth Preparation to Avoid Exposure 21

2.3.3 Managing the Exposed Pulp 21

2.3.3.1 Direct Pulp Capping 22

2.3.3.2 Partial Pulpotomy 22

2.3.3.3 Full Pulpotomy 22

2.3.3.4 Pulpectomy 23

2.3.4 Immature Roots 24

2.4 Materials Used in Vital Pulp Treatment 25

2.4.1 The Role of the Material 25

2.4.2 Calcium Hydroxide 25

2.4.3 Resin-Based Adhesives 27

2.4.4 Hydraulic Calcium Silicate Cements 27

2.4.5 Resin-Based Hydraulic Calcium Silicate Cements 29

2.4.6 Glass Ionomer Cements 30

2.4.7 Experimental Agents Used in Vital Pulp Treatment 31

2.4.8 Tooth Restoration After VPT 32

2.5 Clinical Outcome and Practicalities 32

2.5.1 Vital Pulp Treatment Outcome 32

2.5.2 Discolouration 32

2.5.3 Setting Time and Handling 33

2.6 Conclusion 33

References 34

3 Treatment of Immature Teeth with Pulp Necrosis 47
Paul Cooper, Henry F. Duncan, Matthias Widbiller, and Kerstin M. Galler

3.1 Introduction 48

3.2 Apexification and Root-End Closure 49

3.3 Revitalization 50

3.3.1 Indications 50

3.3.2 Procedure 51

3.3.3 Outcome 51

3.3.4 Limitations 52

3.4 Material Requirements 52

3.4.1 Materials and Applications 52

3.4.2 Biological Requirements 54

3.4.2.1 Bioactivity 54

3.4.2.2 Reaction with Tissue Fluids 54

3.4.2.3 Release of Dentine Matrix Proteins 55

3.4.2.4 Blood Clot 55

3.4.3 Mechanical Requirements 55

3.4.3.1 Impact on Microhardness 55

3.4.3.2 Discolouration 56

3.5 Healing Process and Cellular Responses 57

3.5.1 Biological Aspects 57

3.5.2 Mineralization 60

3.6 Future Directions: Tissue Engineering Approaches 62

3.6.1 Principles of Tissue Engineering 62

3.6.2 Dentine Matrix Proteins and Epigenetic Influences 63

3.6.2.1 Dentine Matrix Components 63

3.6.2.2 Growth Factors and Molecular Modulators 63

3.6.2.3 Epigenetic Influences 64

3.6.3 Cell-Based and Cell-Free Dental Pulp Tissue Engineering 65

3.6.4 Clinical Approaches and Future Perspectives 66

3.7 Conclusion 66

References 66

4 Endodontic Instruments and Canal Preparation Techniques 81
Laurence Jordan, Francois Bronnec, and Pierre Machtou

4.1 Classification and Components of Endodontic Instruments 82

4.1.1 Brief History 82

4.1.2 Alloys 84

4.1.2.1 Carbon Steel versus Stainless Steel 84

4.1.2.2 Nickel–Titanium 84

4.1.3 Manufacture and Standardization 85

4.1.3.1 Standardization of Stainless-Steel Instruments 85

4.1.3.2 Design of Endodontic Instruments: Terms and Definitions 86

4.1.3.3 Physical Properties of Endodontic Instruments: Terms and Definitions 90

4.1.4 Cleaning and Shaping Instruments 90

4.1.4.1 Group 1: Instruments for Hand Use (K-Files, H-Files, Barbed Broaches, Rasps) 90

4.1.4.2 Group 2: Engine-Driven Latch-Type Instruments 94

4.1.4.3 Group 3: Engine-Driven NiTi Rotary Instruments 94

4.1.4.4 Group 4: Engine-Driven Instruments that Adapt Themselves to the Root Canal Anatomy 98

4.1.4.5 Group 5: Engine-Driven Reciprocating Instruments 99

4.1.4.6 Group 6: Sonic and Ultrasonic Instruments 99

4.2 Properties of NiTi Alloys and Improvements by Thermomechanical Treatments 101

4.2.1 Martensitic Transformation 101

4.2.2 Pseudoelastic Properties 102

4.2.3 Transformation Temperatures 104

4.2.4 Manufacturing Processes 105

4.2.5 Flexibility 109

4.2.6 Clinical Implications 112

4.3 Concepts in Root Canal Shaping 112

4.3.1 Instrument Motions 113

4.3.2 Canal Management Strategies 114

4.4 Conclusion 124

References 125

5 Irrigating Solutions, Devices, and Techniques 133
Christos Boutsioukis and Maria Teresa Arias-Moliz

5.1 Introduction 134

5.2 Irrigating Solutions 134

5.2.1 Sodium Hypochlorite 134

5.2.2 Chlorhexidine 136

5.2.3 Ethylenediamine Tetraacetic Acid 136

5.2.4 Citric Acid 137

5.2.5 Etidronic Acid 138

5.2.6 Maleic Acid 138

5.2.7 Ozonated Water 138

5.2.8 Electrochemically Activated Water 139

5.2.9 Saline 139

5.2.10 Mixtures of Irrigating Solutions 139

5.2.10.1 BioPure MTAD 140

5.2.10.2 Tetraclean 140

5.2.10.3 QMix 141

5.2.11 Suggested Irrigation Protocol 141

5.3 Irrigation Techniques 141

5.3.1 Irrigant Delivery Techniques 142

5.3.1.1 Syringe Irrigation 142

5.3.1.2 Negative-Pressure Irrigation 147

5.3.1.3 Combined Positive- and Negative-Pressure Irrigation 149

5.3.2 Irrigant Activation and Agitation Techniques 149

5.3.2.1 Ultrasonic Activation 149

5.3.2.2 Sonic Agitation 152

5.3.2.3 Laser Activation 154

5.3.2.4 Manual Dynamic Agitation 156

5.3.3 Combinations of Techniques 156

5.3.3.1 Continuous Irrigant Delivery and Ultrasonic Activation 156

5.3.3.2 Continuous Irrigant Delivery and Multisonic Activation 157

5.4 Final Remarks 158

References 159

6 Root Canal Filling Materials and Techniques 181
Bun San Chong and Nicholas Chandler

6.1 Introduction 182

6.2 Root Canal Obturation Materials 182

6.2.1 Sealers 182

6.2.1.1 Zinc Oxide-Eugenol Sealers 183

6.2.1.2 Calcium Hydroxide Sealers 184

6.2.1.3 Glass Ionomer Sealers 185

6.2.1.4 Resin Sealers 186

6.2.1.5 Silicone Sealers 187

6.2.1.6 HCSC Sealers 187

6.2.1.7 Other Sealer Types 190

6.2.2 Core Materials 190

6.2.2.1 Silver Points 190

6.2.2.2 Acrylic Points 191

6.2.2.3 Gutta-Percha 191

6.3 Root Filling Techniques 193

6.3.1 Cold Gutta-Percha Condensation Techniques 194

6.3.1.1 Lateral Condensation 194

6.3.1.2 Single-Cone Obturation 195

6.3.2 Heat-Softened Gutta-Percha Techniques 196

6.3.2.1 Intracanal Heating Techniques 197

6.3.2.2 Extracanal Heating Techniques 198

6.3.3 Thermomechanical Compaction 199

6.3.3.1 Vibration and Heat 199

6.3.3.2 Rotating Condenser 199

6.3.4 Other Obturation Techniques 200

6.3.4.1 Pastes 200

6.3.4.2 HCSCs 201

6.3.4.3 Monoblocks 202

6.3.4.4 Hydrophilic Polymers 202

6.4 Orifice Barrier Materials and Tooth Restoration 203

6.5 Retreatment 203

6.6 Conclusion 205

References 205

7 Root-End Filling and Perforation Repair Materials and Techniques 219
Josette Camilleri and Christof Pertl

7.1 Introduction 219

7.2 The Surgical Environment 220

7.3 Materials for Endodontic Surgery 224

7.3.1 Conventional Materials 224

7.3.1.1 Zinc Oxide-Eugenol Cements 225

7.3.1.2 Glass Ionomer Cements 228

7.3.1.3 Filled Resin and Dentine Bonding Systems 231

7.3.1.4 Other Materials and Techniques 233

7.3.2 Hydraulic Cements 233

7.3.2.1 Portland Cement-Based Hydraulic Cements: Types 1–3 234

7.3.2.2 Tricalcium Silicate Cement-Based Hydraulic Cements: Types 4 and 5 245

7.4 Conclusion 248

Acknowledgements 248

References 248

8 Materials and Clinical Techniques for Endodontic Therapy of Deciduous Teeth 263
Nastaran Meschi, Mostafa EzEldeen, Gertrude Van Gorp, and Paul Lambrechts

8.1 Introduction 263

8.2 The Primary Dentine–Pulp Complex 264

8.3 Pulp Treatments in Deciduous Teeth 264

8.3.1 Vital Pulp Therapy 264

8.3.1.1 Incomplete Caries Removal 264

8.3.1.2 Complete Caries Removal 266

8.3.1.3 Restorative Materials for VPT of Deciduous Teeth 267

8.3.2 Pulpectomy 275

8.3.2.1 Technique 275

8.3.2.2 Restorative Materials 278

8.4 Conclusion 280

References 280

9 Adhesion to Intraradicular and Coronal Dentine: Possibilities and Challenges 289
Mutlu Özcan, Claudia Angela Maziero Volpato, and Luiz Fernando D’Altoé

9.1 Introduction 289

9.2 Adhesion to Human Dentine 290

9.3 Adhesion to Root Dentine in Vital Teeth 292

9.4 Pulp Protection Materials and Their Effect on Adhesion to Dentine 293

9.5 Adhesion to Root Dentine in Nonvital Teeth 294

9.6 Conclusion 298

References 298

Index 305