Clinical application of glass ionomer cements in endodontics: case reports

Biological properties versus solubility of endodontic sealers and cements

Endodontic sealers and cements used in root canal treatment have different compositions and properties. Common to all materials is that their primary goal is to fill gaps and voids, making a permanent seal of the root canal system. Furthermore, aspects such as antibacterial properties, cytotoxicity, setting time, solubility and biocompatibility are also crucial and ought to be considered. Over the years, a shift in the view on the importance of these aspects has ocurred. Whereas the antibacterial properties were considered important when the technical factors in endodontics were less developed, the sealing ability and biocompatibility have later been considered the most critical factors. The introduction of tricalcium silicate cements and sealers has led to a renewed interest in material properties, as these cements seem to have good sealing ability and at the same time combine favourable antimicrobial effects with excellent biocompatibility. This review discusses how the various properties of root canal sealers and cements may conflict with the primary aim of providing a permanent seal of the root canal system.

Management of a Large Internal Resorption Lesion with Metal Reinforced Glass Ionomer Cement

Mineral trioxide aggregate is the mainstay of treatment of large internal resorption defects. But its cost may be a deterrent to its use in some patients. The present case report describes the successful endodontic management of an extensive internal resorptive lesion in a mandibular molar with metal reinforced glass ionomer cement.

The use of glass ionomer cements in both conventional and surgical endodontics

The capacity to bond to dental tissues, especially to dentine, their long-term fluoride release and their biocompatibility make glass ionomer cements (GICs) advantageous for use in endodontics, as well as in restorative dentistry. This review provides information on the basic properties of GICs, such as adhesion, antimicrobial effects and biocompatibility, particularly as they relate to use in endodontics. Indications for the use of GICs in endodontics are orthograde root canal sealing, root-end filling, repair of perforations and root resorption defects, treatment of vertical fractures and maintenance of the coronal seal. The paper includes a review on each of these indications. It is concluded that in spite of the critical handling characteristics and the inconclusive findings regarding sealing ability and antimicrobial activity, there is substantial evidence to confirm their satisfactory clinical performance. Both soft tissue and bone compatibility make them suitable for use during endodontic surgery.

Preventive effect of tooth fracture by pulsed Nd:YAG laser irradiation with diamine silver fluoride solution

OBJECTIVE

The purpose of the present study was to evaluate the preventive effect of pulsed Nd:YAG laser irradiation with 38% diamine silver fluoride [Ag(NH3)2F] solution for the fracture of endodontically treated teeth in vitro.

BACKGROUND DATA

There have been no reports on the preventive effect of tooth fracture using Nd:YAG laser with Ag(NH3)2F solution.

MATERIALS AND METHODS

Twenty-eight human extracted teeth were used in this study. The teeth were randomly classified into four groups: control group, where tooth surfaces were not submitted to any treatment; group 1, where tooth surfaces were coated with 38% Ag(NH3)2F solution; group 2, where tooth surfaces were coated with Ag(NH3)2F solution and irradiated by pulsed Nd:YAG laser for 2 sec; and group 3, where tooth surfaces were coated with Ag(NH3)2F solution and irradiated by pulsed Nd:YAG laser for 10 sec. After preparation, shear tests were performed and the maximum load for the fracture was measured. Results were analyzed using the Scheffe test, and difference at p < 0.05 was considered significant.

RESULTS

The failure load for group 2 (mean, 182.5 kg) had the highest mean value and differed significantly from those for the control group (mean, 146.3 kg) and group 1 (mean, 147.1 kg; p < 0.05). The failure loads for groups 1 and 3 (mean, 150.0 kg) did not differ significantly from that for the control group (p > 0.05).

CONCLUSION

The results show that the application of 38% Ag(NH3)2F solution followed by pulsed Nd:YAG laser irradiation for 2 sec is useful for prevention of tooth fracture at endodontically treated teeth.

The structure of dentine in the apical region of human teeth

AIM

To study the structure of the apical region of human teeth with emphasis on dentinal tubules and their branches.

METHODOLOGY

This descriptive histological study employed demineralized stained sections for light microscopy, demineralized unstained sections for scanning electron microscopy, and undemineralized, acid-etched specimens for confocal tandem scanning microscopy.

RESULTS

The apical portion of human teeth showed marked variations in structure, including accessory root canals, areas of resorption and repaired resorptions, occasional attached, embedded and free pulp stones, varied amounts of irregular secondary dentine, and even cementum-like tissue lining the apical root canal wall. The apex often deviated from the long axis of the root canal. Primary dentinal tubules were irregular in direction and density. Some areas were devoid of tubules.

CONCLUSIONS

The irregular and variable structure of the apical region of human teeth represent special challenges during endodontic therapy. Obturation techniques based on the penetration of adhesives into dentinal tubules are unlikely to be successful and adhesive techniques must depend on impregnation of a hybrid layer.

Evaluation of root reinforcement of endodontically treated teeth

OBJECTIVES

The purpose of this study was to test the root reinforcing capabilities of a glass ionomer sealer and to test whether pretreatment of the instrumented canal to alter or remove the smear layer might enhance the reinforcement.

STUDY DESIGN

Ninety single-canaled roots of standardized dimensions were instrumented to International Standards Organization size 45 and were analyzed for resistance to vertical fracture. Six groups were tested (n = 15).

RESULTS

No significant difference in fracture resistance was observed between any of the groups.

CONCLUSIONS

Under the conditions of this study, reinforcement of endodontically treated mature teeth by placement of adhesive materials in the root was not demonstrated.

The shear bond strength of glass ionomer cement sealers to bovine dentine conditioned with common endodontic irrigants

AIM

The aim of this in vitro study was to evaluate the shear bond strength of commercially available and experimental glass ionomer cement (GIC) sealers to dentine exposed to common endodontic irrigants.

METHODOLOGY

The enamel of 90 bovine incisor crowns, randomly divided into nine equal groups, was ground to expose the superficial dentine layer. The exposed surface was conditioned with either: (i) distilled H2O; (ii) 2.6% NaOCl; or (iii) 17% EDTA followed by 2.6% NaOCl. Five cc of each irrigant was applied over a 30-second period. The following GIC sealers were tested: (i) Ketac-Endo; (ii) KT-308, an experimental sealer; and (iii) ZUT, a combination of KT-308 and an antibacterial agent (0.2% by weight). The test sealers were applied to form cylinders with a standardized contact surface area (17.8 mm2) on the conditioned dentine surfaces. Specimens were bench set for 90 min and stored in distilled water at 37 degrees C for 48 h, then tested to failure for shear bond strength (MPa) in an Instron machine.

RESULTS

KT-308 and ZUT had significantly higher MPa values than Ketac-Endo (two-factor ANOVA, P < 0.0001), regardless of the dentine conditioning. All specimens conditioned with 17% EDTA and 2.6% NaOCl combined had significantly lower MPa values than those conditioned with water or 2.6% NaOCl alone (P < 0.02).

CONCLUSIONS

It was concluded that the experimental sealers KT-308 and ZUT bonded better to bovine dentine than Ketac-Endo, and that the bond of all three GIC sealers was better with the smear layer present.

Comparison of apical leakage between Ketac Endo sealer and Grossman sealer

Forty-eight extracted human teeth were prepared for study to compare Ketac Endo cement with Grossman's cement in preventing leakage of a dye. Four groups were formed: (1) Grossman's sealer with a single gutta percha cone; (2) Grossman's sealer with lateral condensation of gutta percha; (3) Ketac Endo sealer with a single cone of gutta percha; and (4) Ketac Endo sealer with lateral condensation of gutta percha. The teeth were immersed in the dye for 10 days, after which they were rinsed in running tap water and cleared for observation. In the groups of teeth evaluated by three individual evaluators, the results consistently showed less leakage with glass ionomer sealers (groups 3 and 4) than with the Grossman's sealers (groups 1 and 2). The best results were noted when Ketac Endo sealers were used with lateral condensation.

Endodontic and restorative management of incompletely fractured molar teeth

The treatment of fractured teeth poses significant problems for the practitioner. However, once the treatment planning decision has been made to attempt to retain the tooth, various practical regimens are available to effect this goal. This paper addresses the specific use of glass ionomer in the restorative management of incompletely, vertically fractured molar teeth integrated with specific root canal treatment techniques.

Influence of endodontic materials on the bonding of glass ionomer cement to dentin

We assessed the bond strength of a glass ionomer cement to dentin that had been in contact with different materials. Flat dentin surfaces in freshly extracted human teeth were covered for 48 h with a 1 mm layer of a variety of materials that are used for temporary filling or root canal sealing. The products were mechanically removed and a glass ionomer cement cylindrical specimen bonded to the dentin surface. After 7-days immersion in 37 degrees C water the tensile bond strength was tested. The results were compared with those on dentin surfaces not in contact with any endodontic material. The statistical analysis showed that none of the materials used interfered with the bonding of the glass ionomer to dentin.

Multidisciplinary approach to the repair of vertically fractured teeth

This case report describes the treatment of a vertically fractured upper left second molar. The two segments were extracted separately. The periodontal ligament was protected from damage extraorally by soaking it with Hanks' balanced salt solution. The two segments were bonded with the use of a biocompatible glass ionomer bone cement and replanted in conjunction with an expanded polytetrafluoroethylene (gore-tex) membrane. After 1 yr the tooth functions normally and is clinically and radiographically within normal limits.