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The purpose of a root-end filling is to establish a seal between the root canal space and the periradicular tissues. As root-end filling materials come into contact with periradicular tissues, knowledge of the tissue response is crucial. Almost every available dental restorative material has been suggested as the root-end material of choice at a certain point in the past. This literature review on root-end filling materials will evaluate and comparatively analyse the biocompatibility and tissue response to these products, with primary focus on newly introduced materials.

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The purpose of this study was to compare mineral trioxide aggregate (MTA; Dentsply, Tulsa Dental, Tulsa, OK, USA), which is widely used as root-end filling material, with DiaRoot BioAggregate (DB; Innovative BioCaramix Inc, Vancouver, BC, Canada), newly developed product, by using MG63 osteoblast-like cells. MTA, DB, and Intermediate Restorative Material (IRM; Dentsply Caulk, Milford, DE, USA) were used for root-end filling material while tissue culture plastic was used for control group. Each material was mixed and, the mixtures were left to set for 24 hours. MG63 cells were seeded to each group and then they were cultured for attachment for 4 hours. Following the attachment of cells to the root-end filling material, early cellular response was observed. After another 12 hours'culture, the level of attachment between cells and material was observed and in order to identify the effect of each material to bone formation, transforming growth factor beta1 (TGFβ1) and osteocalin (OC) were estimated by using enzyme-linked immunosorbent assay (ELISA), and the amount of alkaline phosphatase (ALP) was also measured. The data were analyzed using one-way ANOVA. As a result, only at OC and the number of cells which were attached to materials, there was no statistical difference between MTA and DB. At other items, there was statistically significant difference in all groups. Although DB has not shown exactly the same cellular response like that of MTA, the number of attached cells shows that biocompatibility of the material and OC indicates bone formation rate. Therefore, if DB is used for root end filling material, it is expected to lead to similar results to MTA.

Citations

Citations to this article as recorded by  

• Comparative analysis of physicochemical properties of root perforation sealer materials
  Maura Cristiane Gonçales Orçati Dorileo, Fábio Luis Miranda Pedro, Matheus Coelho Bandeca, Orlando Aguirre Guedes, Ricardo Dalla Villa, Alvaro Henrique Borges
  Restorative Dentistry & Endodontics.2014; 39(3): 201.     CrossRef
• Biocompatibility of root-end filling materials: recent update
  Payal Saxena, Saurabh Kumar Gupta, Vilas Newaskar
  Restorative Dentistry & Endodontics.2013; 38(3): 119.     CrossRef

Since its introduction in 1993, Mineral Trioxide Aggregate (MTA) has been shown to be superior to others in sealing, biocompatibility, and many other aspects of clinical endodontics. MTA is primarily Portland cement with bismuth oxide as a radiopacitifier.

Although some studies suggested that the reasonable-priced Portland cement could be used instead of MTA, but MTAs are different from Portland cement in its composition, especially in heavy metal contents. Therefore, clinicians should be meticulous adapting the Portland cement as a MTA substitute.

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• Endodontic management of a maxillary lateral incisor with dens invaginatus and external root irregularity using cone-beam computed tomography
  Young-Jun Lim, Sook-Hyun Nam, Sung-Ho Jung, Dong-Ryul Shin, Su-Jung Shin, Kyung-San Min
  Restorative Dentistry & Endodontics.2012; 37(1): 50.     CrossRef

We evaluated in vitro microleakage of Mineral Trioxide Aggregate (MTA) powder with 4-methacryloxyethyl trimellitate anhydride (4-META) / methyl methacrylate (MMA) & tri-n-butylborane (TBB) resin as a retrograde filling material by using methylene blue dye method.

Fifty-two single rooted, extracted teeth were instrumented and obturated with gutta percha and AH plus sealer. The apical 3mm of each root was resected and 3mm deep ultrasonic root end preparation was done. External surface of roots was coated with nail varnish. Prepared teeth were randomly divided into five groups; Negative control: completely covered with nail varnish; Positive control: coated with nail varnish except for apical foramen; Group 1 (retrofilled with Portland cement); Group 2 (retrofilled with MTA); Group 3 (retrofilled with MTA powder mixed with 4-META/MMA & TBB resin). Immediately after completion of root-end filling, all specimens were submerged in methylene blue dye for 72 hours in 37℃ incubator. The roots were longitudinally sectioned and measured for extent of dye penetration by three different examiners under microscope (×10). The results were statistically analyzed using one way ANOVA and Turkey's HSD test. No leakage was evident in negative control and complete leakage in positive control group. Group 3 showed significantly less leakage than group 1 and 2 (p < 0.01). There was no significant difference between group 1 and 2 (p > 0.01).

It was concluded that MTA powder with 4-META/MMA & TBB resin was excellent in reducing initial apical microleakage.

Citations

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• Characteristics of novel root-end filling material using epoxy resin and Portland cement
  Sang-Jin Lee, Jin Chung, Hee-Sam Na, Eun-Joo Park, Hyo-Jin Jeon, Hyeon-Cheol Kim
  Clinical Oral Investigations.2013; 17(3): 1009.     CrossRef
• Sealing Ability of Three Different Materials Used as Retrograde Filling
  Ji-Hoon Park, Seung-Bok Kang, Yong-Hoon Choi, Ji-Hyun Bae
  Journal of Korean Dental Science.2012; 5(2): 60.     CrossRef
• Physical properties of novel composite using Portland cement for retro-filling material
  Sang-Jin Lee, Ok-In Cho, Jiwan Yum, Jeong-Kil Park, Bock Hur, Hyeon-Cheol Kim
  Journal of Korean Academy of Conservative Dentistry.2010; 35(6): 445.     CrossRef

This study was performed to assess the radiopacity of a variety of canal filling and retrograde root-end filling materials according to the specification concerning root canal obturation materials.

Ten materials including Gutta-percha pellets, amalgam, Fuji II LC, Dyract® AP, Super EBA®, IRM®, AH 26®, Sealapex™, Tubli-Seal™ and dentin were evaluated in this study. In the first part, densitometric reading of an each step of aluminum step wedge on occlusal film were performed at 60 kVp (0.2, 0.3, 0.4 s), 70 kVp (0.2, 0.3, 0.33 s) to decide appropriate voltage and exposure time. In the second part, ten specimens which are 5 mm in diameter and 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 mm in thickness, were fabricated from each material studied. The specimens were radiographed simultaneously with an aluminum step wedge under decided condition (60 kVp, 0.2 s). The mean radiographic density values of the materials were transformed into radiopacity expressed equivalent thickness of aluminum (mm Al).

The following results were obtained.

Among the various conditions including 0.2 s, 0.3 s, 0.4 s at 60 kVp and 0.2 s, 0.3 s, 0.33 s at 70 kVp, the appropriate voltage and exposure time that meet the requirement of density from 0.5 to 2.0 was 0.2 s at 60 kVp.

It suggests that all experimental canal filling and retrograde root-end filling materials have a sufficient radiopacity that meet the requirement concerning root canal obturation materials except for Fuji II LC and Dyract.

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• Evaluation of prognosis related to compliance with supportive periodontal treatment in patients with chronic periodontitis: a clinical retrospective study
  Jong-Bin Lee, Hye-Jung Shin, Dae-Yeob Kim, Eun-Kyoung Pang
  Journal of Periodontal & Implant Science.2019; 49(2): 76.     CrossRef

The purpose of this study is to evaluate the sealing effect of several root-end filling materials using spectrophotometric analysis. 180 single root teeth with one canal were instrumented and canal filled. Root resected and root end preparation was made. Teeth were randomly classified to 5 experimental group(MTA, EBA, IRM, TCP, ZOE) and 1 control group according to root-end filling material MTA group used PRO ROOT MTA, EBA group used Super EBA, TCP group used NEW APATITE LINER TYPE II main component of which is α-tricalcium phosphate(TCP). According to manufacture's instruction experimental material was mixed and retrfilled. After 2% methylene blue solution penetration absorbance for each test sample was measured with spectrophotometer (JASCO UV-530, Japan).

The mean absorbance of control and experimental group was as follows;

MTA : 0.092, IRM : 0.226, Super EBA : 0.255, ZOE : 0.374, Control : 0.425, TCP : 0.501 and the result analyzed by Turkey test at P=0.05 level.

Conclusions of this study are as follows;

The absorbance increase in follwing sequence MTA, IRM, Super EBA, ZOE, Control, TCP.