Endodontic Materials

Securing the root canal

Endodontic materials

Master cones

Sealers

Root-end filling materials

Root-end filling materials

Materials that are usually used for otherpurposes like

IRM

Super EBA

Amalgam

Mineral Trioxide Aggregate (MTA)

MINERAL TRIOXIDEAGGREGATE

Composition of MTA

Calcium Silica Aluminium Bismuth

Camilleri J, Montesin FE, Brady K, Sweeney R, Curtis RV, Pitt Ford TR.The constitution of mineral trioxide aggregateDental Materials 2005; 21:297-303

Elemental Constitution

Phase constitution

Tricalcium silicate 53%

Dicalcium silicate 22%

Tricalcium aluminate

Camilleri J, Montesin FE, Brady K, Sweeney R, Curtis RV, Pitt Ford TR.The constitution of mineral trioxide aggregateDental Materials 2005; 21:297-303

Hydration of MTA

2(3CaO.SiO2) + 6H2O 3CaO.2SiO2.3H2O + 3Ca(OH)2tricalcium silicate calcium silicate hydrate calcium

hydroxide

2(2CaO.SiO2) + 4H2O 3CaO.2SiO2.3H2O + Ca(OH)2dicalcium silicate calcium silicate hydrate calcium

hydroxide

3CaO.Al2O3 + CaSO4 + H2O 3CaO.Al2O3.3CaSO4.31H2Otricalcium gypsum ettringite

aluminate

Camilleri J.Hydration mechanisms of mineral trioxide aggregate.International Endodontic Journal 2007; 40: 462-70.

Hydration products

Calcium silicate hydrate 49.5%

Calcium hydroxide 14.4%

Ettringite 2.1%

Bismuth oxide 8.4%

Unhydrated calcium silicate 25.5%

Camilleri J.Characterization of hydration products of mineral trioxide aggregate.International Endodontic Journal 2008; 41: 408-17.

Camilleri J.Hydration mechanisms of mineral trioxide aggregate.International Endodontic Journal 2007; 40: 462-70.

Initial stages of reaction

Formation of calcium silicate hydrate

Coating of cement particles with silicate hydratepreventing further reaction

Tricalcium aluminate dissolves and reacts withthe calcium and sulphate ions present in theliquid phase producing ettringite that alsoprecipitates on the cement particle surface.

Dormant period

The hydrate coating on the cement grainsprevents further hydration. Dormant period is 1-2 hours of relative inactivity where the cementis plastic and workable.

Acceleration stage

The progress of hydration accelerates again. Therate of tricalcium silicate hydration increases andmore calcium silicate hydrate gel is formed.

The hydration of dicalcium silicate also increases atthis stage.

Sulphate ions get depleted and monosulphate forms

Crystalline calcium hydroxide precipitates from theliquid phase.

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70

Si/Ca

Al/Ca

Mainly C-S-H

Higher Al/Ca

Mainly CH

Mainly Ett

Refs

AFm

CH

AFt

C-S-H

Camilleri J.The hydration mechanisms of mineral trioxide aggregate.International Endodontic Journal 2007; 40:462-470.

Only 8.4% of the bismuth oxide remains unbound. Therest is taken up in the calcium silicate hydrate structurereplacing the silica.

Camilleri J.Characterization of hydration products of mineral trioxide aggregate.International Endodontic Journal 2008; 41: 408-17.

Release of calcium hydroxide

Release of bismuth

Camilleri J.Characterization of hydration products of mineral trioxide aggregate.International Endodontic Journal 2008; 41: 408-17.

Leached minerals

Camilleri J.Characterization of hydration products of mineral trioxide aggregate.International Endodontic Journal 2008; 41: 408-17.

Properties of MTA

0

2

4

6

8

10

12

14

mixing 1 5 24 168 672

time/h

pH

gopc wopc gopc solution wopc solution

Camilleri JThe use of Portland cement and its modified forms as a dental core build-up material.PhD thesis 2006

pH

Camilleri J, Montesin FE, Papaioannou S, McDonald F, Pitt Ford TR.Cytomorphology of osteoblasts exposed to two commercial forms of MTAInternational Endodontic Journal 2004; 37: 699-704.

Biocompatibility

Camilleri J, Montesin FE, Di Silvio L, Pitt Ford TR.The constitution and biocompatibility of accelerated Portland cement for endodontic use.International Endodontic Journal 2005; 38: 834-842.

Material biocompatibility

Elution biocompatibility

Strength

40

86.02

30.4

~ 70

N/mm2

Reportedstrength

Torabinejad et al. 1995

Islam et al. 2006

Ber et al. 2007

Nekoofar et al. 2007

Publication

3

4

3

/

weeks

Age of test

Camilleri JThe use of Portland cement and its modified forms as a dental core build-upmaterial. PhD thesis 2006

Marginal adaptation

Marginal adaptation

Camilleri JThe use of Portland cement and its modified forms as a dental core build-upmaterial. PhD thesis 2006

Improvement in properties

Setting time

1) Addition of an accellerator Calcium chloride

Mixture of methyle cellulose and calciumchloride

Calcium nitrate

Calcium formate

Sodium hypochlorite

Lidocaine

Chlorhexidine gluconate

Sodium phosphate

Saline

Mode of action of the accellerator

Saline Sodium chloride usually accelerates the cement hydration

but can act as a retarder especially in the initial stages

Calcium chloride Accelerates the reaction between tricalcium aluminate and

gypsum Accelerates hydration of tricalcium silicate

Calcium formate, calcium nitrate Accelerates hydration of tricalcium silicate

Paillere AM et al. , RILEM Report 10; 1995

27/

50253583/

21560

601020

120Un-set

902626

Abdullah et al. 2002Bertoluzzi et al. 2006

Kogan et al. 2006Kogan et al. 2006

Wiltbank et al. 2007Ber et al. 2007

Gandolfi et al. 2008Ber et al. 2007Ber et al. 2007

Wiltbank et al. 2007Wiltbank et al. 2007

Kogan et al. 2006Kogan et al. 2006Kogan et al. 2006Kogan et al. 2006Ding et al. 2008

Huang et al. 2008

1510355251

1/2

1-10/25-5020/2//

1515

Calcium chloride

Methyl celluloseMethyl cellulose and calcium

chloridecalcium nitrite/nitrate

Calcium formateSodium hypochlorite

LidocaineChlorhexidine gluconate

SalineSodium phosphate

minutes%

Setting timePublicationDosageAccellerator

Effects of addition of the accelerator

None of the accelerators reduced the setting time to clinicallyacceptable levels

Calcium chloride absorbs moisture from the atmosphere

Material strength was reduced Kogan et al. 2006, Ber et al. 2007

Workability reduced Kogan et al. 2006

Increase of heat of hydration Wiltbank et al. 2007

Increase in pH and calcium ion release Wiltbank et al. 2007, Bertoluzzi et al. 2006

Same dimensional stability Wiltbank et al. 2007

Same biocompatibility as MTA Ding et al. 2008

2) Omission of gypsum from the manufacturing processthus producing a clinker

On hydration the tricalcium aluminate reacts producingcalcium aluminate hydrate resulting in a flash set.

Camilleri J, Montesin FE, Di Silvio L, Pitt Ford TR.

The constitution and biocompatibility of accelerated Portland cement for endodontic use.

International Endodontic Journal 2005; 38: 834-842.

Camilleri J.

The physical properties of accelerated Portland cement for endodontic use.

International Endodontic Journal 2008; 41: 151-7.

Setting time: 8 minutes

Material similar to MTA Composition Biocompatibility strength pH Water absorption

Camilleri J, Montesin FE, Di Silvio L, Pitt Ford TR.The constitution and biocompatibility of accelerated Portland cement for endodontic use.International Endodontic Journal 2005; 38: 834-842.

Camilleri J.The physical properties of accelerated Portland cement for endodontic use.International Endodontic Journal 2008; 41: 151-7.

3) Addition of calcium aluminate cement

Setting time: 5 minutes

Increase in compressive strength

Reduced biocompatibility due to lack of calcium hydroxide in the set cement

Camilleri J.The biocompatibility of modified experimental Portland cement with potential for use in dentistry.International Endodontic Journal International Endodontic Journal 2008; 41: 1107-14.

Camilleri J.Characterization and chemical activity of the Portland cement and two experimental cements withpotential for use in dentistry.International Endodontic Journal 2008; 41: 791-9.

Camilleri J.Modification of MTA. Physical and mechanical properties.International Endodontic Journal 2008; 41: 843-9.

Strength

Compressive strengths are similar to that of temporaryrestorative materials. Strength can be improved by:

Addition of chemical admixturesCamilleri J.The physical and chemical properties of accelerated Portland cement for endodontic

use.International Endodontic Journal 2008; 41: 151-7.

Addition of mineral admixturesCamilleri J, Montesin FE, Curtis RV, Pitt Ford TR.Characterization of Portland cement for use as a dental restorative material.Dental Materials 2006; 22: 569-575.

Addition of mineral admixtures reduce materialbiocompatibility

Camilleri J, Montesin FE, Juszczyk AS, Papaioannou S, McDonald F, Curtis RV, Pitt Ford TR.The constitution, physical properties and biocompatibility of modified accelerated Portland cement.Dental Materials 2008; 24: 341-50

Effects of dental procedures

Reductions in pH

Reduction in surface micro-hardnessNamazikhah MS, Nekoofar MH, Sheykhrezae MS, Salariyeh S, Hayes SJ, BryantST,Mohammadi MM, Dummer PM. The effect of pH on surface hardness and microstructure ofmineral trioxide aggregate. International Endodontic Journal 2008; 41: 108-16.

Reduction in strengthWatts JD, Holt DM, Beeson TJ, Kirkpatrick TC, Rutledge RE. Effects of pH and mixing agentson the temporal setting of tooth-colored and gray mineral trioxide aggregate. Journal ofEndodontics 2007; 33: 970-3.

Shie MY, Huang TH, Kao CT, Huang CH, Ding SJ. The effect of a physiologic solution ph onproperties of white mineral trioxide aggregate. J Endod 2009;35:98-101.

Increased micro-leakageSaghiri MA, Lotfi M, Saghiri AM, Vosoughhosseini S, Fatemi A, Shiezadeh V, Ranjkesh B.Effect of pH on sealing ability of white mineral trioxide aggregate as a root-end filling material. JEndod 2008;34:1226-9.

Use of irrigating solutions

EDTA

Reduction in Portland peak suggesting reduceddeposition of calcium hydroxide

Lee YL, Lin FH, Wang WH, Ritchie HH, Lan WH, Lin CP. Effects of EDTA on the hydrationmechanism of mineral trioxide aggregate. Journal of Dental Research 2007; 86: 534-8.

Bio-Pure MTA

Increase in calcium chelation

Smith JB, Loushine RJ, Weller RN, Rueggeberg FA, Whitford GM, Pashley DH, Tay FR.Metrologic evaluation of the surface of white MTA after the use of two endodontic irrigants.Journal of Endodontics 2007; 33: 463-7.

Testing procedures

Dye solutions

Camilleri J, Pitt Ford TR. Evaluation of the effect of tracer pH on the sealing ability of glassionomer cement and mineral trioxide aggregate. Journal of Materials Science; Materials inMedicine 2008; 19: 2941-8.

A reduction in pH resulted in a variation inthe hydration mechanism of MTA

Absence of needle-like structures normallypresent within hydrated material

Lee YL, Lee BS, Lin FH, Yun Lin A, Lan WH, Lin CP. Effects of physiological environmentson the hydration behavior of mineral trioxide aggregate. Biomater 2004;25:787-93.