Dangers of bismuth iodoform paraffin paste

Comparison of clinical performance of obturating materials in pulpectomies: A randomized clinical trial

BACKGROUND

Chemomechanical debridement is insufficient to disinfect all bacteria from the root canals of primary teeth, and obturation of canals with an appropriate material thus acquires excellent importance and remains a critical step in the ultimate success of pulpectomy.

AIM

The aim of the study was to compare and evaluate Endoflas, Metapex, and a mixture of calcium hydroxide (CH) and zinc oxide (ZnO) as obturating materials (OMs) in primary mandibular second molars.

MATERIALS AND METHODS

Seventy-five mandibular second primary molars requiring pulpectomies were identified in children aged 4-8 years. They were randomly allocated to the three treatment groups according to the type of OM received using the block randomization technique. After the completion of chemomechanical debridement, the canals were filled with Endoflas, Metapex, and CH-ZnO mixture, respectively. The intergroup clinical and radiographic comparison was made based on Coll and Sadrian criteria to decipher their clinical performance at 1, 3, and 6 months.

RESULTS

No statistically significant differences between the groups were observed at any evaluation time interval (P > 0.05). At 6 months, the clinical success rates were 95.2% in Endoflas, 96% in Metapex, and 95.8% in the CH and ZnO mixture groups, respectively. The materials, however, behaved differently in different clinical situations.

CONCLUSION

Based on the observations, all three OMs showed similar clinical success in maintaining tooth functioning, but their use can be restricted to indications. However, prospective studies with longer follow-ups with more stringent eligibility criteria are required to reach more definitive conclusions.

Iodide-Induced Severe Encephalopathy: A Case Report and Literature Review

A physically independent and mentally competent 61-year-old gentleman was diagnosed with left upper alveolar spindle cell carcinoma. He underwent left infrastructure maxillectomy with reconstruction and had bismuth iodoform paraffin paste packed in the post-operative cavities. The patient subsequently exhibited labile emotions and acute delirium. Further investigation showed that his urine iodine level was highly elevated. He eventually made a full recovery and returned home.

Bismuth release from endodontic materials: in vivo analysis using Wistar rats

Calcium silicate-based materials are used to block the communication between the root canal and the periodontal ligament space. This brings the materials into contact with tissues and the potential for local and systemic elemental release and movement. The aim of the study was to evaluate the elemental release of bismuth from ProRoot MTA in contact with connective tissues after 30 and 180 days as well as any accumulation in peripheral organs using an animal model. Tricalcium silicate and hydroxyapatite containing 20% bismuth oxide (HAp-Bi) were used as controls. The null hypothesis was that bismuth migrates from tricalcium silicate-based materials when associated with silicon. The materials were examined using scanning electron microscopy, energy dispersive spectroscopy (SEM/EDS) and X-ray diffraction prior to implantation as well as using SEM/EDS, micro X-ray fluorescence and Raman spectroscopy after implantation to assess elemental presence in surrounding tissues. Histological analysis was used to evaluate the changes in tissue architecture and inductively coupled plasma mass spectrometry (ICP-MS) was used to investigate the elemental deposition. For the systemic investigation, routine blood analysis was performed and organs were obtained to evaluate the presence of bismuth and silicon using ICP-MS after acid digestion. In the histological analysis of the implantation sites, macrophages and multinucleated giant cells could be observed after 30 days which after 180 days became a chronic infiltrate; although, no major differences were identified in red and white blood cell analyses and biochemical tests. Implantation altered the materials as observed in the Raman analysis and bismuth was detected both locally and within kidney samples after both periods of analysis, indicating the potential for accumulation of bismuth in this organ. Smaller amounts of bismuth than observed in the kidney were also detected in blood, liver and brain for the ProRoot MTA and HAp-Bi after 180 days. Bismuth was released from the ProRoot MTA locally and was detected systemically and in samples without silicon; thus, the null hypothesis was rejected. The bismuth release demonstrated that this element accumulated both locally and systemically, mainly in the kidneys in comparison with brain and liver regardless of the material base.

Comparative evaluation of zinc oxide-eugenol and zinc oxide with Neem oil in root canal treatment of primary teeth: Split-mouth study with 12 months follow-up

Background

Various root canal filling materials are used to preserve pulp tissue involved carious the primary tooth. A single material that fulfills all the requirements of an ideal root canal filling material for primary teeth is yet unavailable. Hence, this study was initiated to evaluate clinically and radiographically, the efficacy of two obturating materials - zinc oxide eugenol (ZOE) and zinc oxide mixed with Neem oil (ZON) for 12 months.

Aims

To assess the success rate of a mixture of zinc oxide and neem oil in comparison to zinc oxide-eugenol paste, as an obturating material in primary molars. To compare the efficacy of ZON as an obturating material at the various time interval of 3, 6, 9, and 12 months postoperatively.

Materials and methods

This split-mouth, double-blind study was performed on 24 children aged 5-7 years, who presented with bilaterally infected primary molars. Total 48 infected primary molars were divided into two groups for pulpectomy followed by obturation with ZOE and ZON, respectively. Randomization with the chit-pick method, for the control and experimental drug, was performed. A follow-up for 12 months was performed. The Chi-square test was used for inter-group comparison and the Z test was used for the analysis of data over a period of time.

Results

Overall clinical findings in this study revealed 91.7% results in ZOE compared with 100% results in the ZON group. The radiographical findings revealed 91.7% results in ZOE compared with 100% success in the ZON group.

Conclusion

ZON demonstrated excellent effectiveness as an obturating material in the 12-month follow-up period as compared to ZOE in primary teeth. The efficacy elicited in this study could be a basis to recommend ZON as herbal alternative obturation material.

Volumetric Assessment of Root Canal Obturation Using 3% Nano-Chitosan versus Zinc Oxide Eugenol (ZOE) and Iodoform-Calcium Hydroxide (Metapex), in Primary Root Canals Shaped with Rotary versus Manual Methods: A Preliminary In-Vitro Spiral CT Study

Objectives:

In this study, chitosan was introduced and used as a substitute for pulpectomy obturation against conventional materials: zinc oxide eugenol (ZOE) and iodoform-calcium hydroxide (Ca(OH)₂). Efficacies of rotary versus manual instrumentations were also compared.

Materials and Methods:

This preliminary study was performed on 152 intact nonresorbed root canals of primary molars divided into rotary (n=78) versus hand-instrumentation (n=74) and into ZOE (n=53), iodoform-Ca(OH)₂ (n=50), and 3% nano-chitosan (n=49). Canals were cleaned/shaped using hand or rotary files. Canal spaces were measured using spiral computed tomography and obturated using the three materials. The percentages of obturation volume (POV) were estimated. Rotary and manual instrumentations were compared in terms of canal spaces before and after obturation. Three obturation materials were also compared regarding canal spaces after obturation (α=0.05).

Results:

Average POVs of materials were 96.54% (ZOE), 97.87% (Metapex), and 74.74% (nano-chitosan; P=0.000). POV of chitosan differed from the other two (P<0.001) but the other two were similar (P=0.896). Average POVs were 91.46% (manual) and 88.51% (rotary); the difference was not significant (P=0.322). Preobturation spaces of canals for different methods were 3.89 mm ³ (manual) and 3.26 mm ³ (rotary); the difference was significant (P=0.013). Two-way ANCOVA showed a significant effect of materials (P<0.001) but not root length (P=0.585) or shaping methods (P=0.362) on POVs.

Conclusion:

Nano-chitosan showed a considerable success rate but it still needs reformulation as it was weaker than the extremely successful commercial competitors. Rotary instrumentation can provide results similar to hand-filing in terms of POV although it might yield smaller canals.

Calcium Hydroxide And Zinc Oxide Eugenol As Root Canal Filling Materials In Primary Molars: A Comparative Study

Calcium hydroxide, a material widely used for the treatment of permanent teeth has not been used frequently for endodontic treatment in primary teeth. A comparative evaluation of calcium hydroxide and zinc oxide eugenol used as root canal filling materials in primary molars is presented.