Obturating materials for primary tooth

Presented by
Mutyala jhansi (JR2)
Paediatric and preventive dentistry
KGMU

The goal of an any procedure performed in a primary tooth are to
Maintain arch length Preserve masticatory function
Remove acute and chronic infection from tooth or oral cavity

Pulp therapy for pulpally involved primary teeth continues to be a
challenge to clinicians.
Tortuous and ribbon shaped anatomy of the primary teeth
Physiological resorption of roots

Primary molar roots are usually curved
to allow for the development of the
succedaneous tooth.
During instrumentation, these curves increase the chance of
perforation of the apical portion of the root or the coronal one-third
of the canal into the furcation.

PHYSIOLOGICAL RESORPTION OF ROOTS
Resorption causes the position of the apical foramen to change
continuously.
Lateral and accessory canals exist in most primary molars and are
more prevalent in mandibular molars compared with maxillary
ones.
Accessory canals in the furcation of primary molars can explain the
frequent presence of radiolucency in the furcation area of necrotic
teeth.

Due to the complex morphology of the root canal system in primary
teeth, the clinician must rely primarily on chemical cleansing and
sterilization and secondarily on mechanical instrumentation during
pulpectomy procedure.
And in order to increase the chance of success of the endodontic
treatment, substances with antimicrobial properties are frequently
used as root canal filling materials in deciduous teeth

STEPS IN PULPECTOMY
After attaining profound anesthesia, isolate the affected tooth with
rubber dam.
Prepare the access ( with high speed hand piece and fissure bur)
Remove all caries portion with round bur, unroof the pulp chamber.
Excise the coronal portion of the pulp using a round bur
Extirpate the radicular portion of pulp with a barbed broach
After extirpation, irrigate the canals, on completion dry the canals
thoroughly with paper points
Obturate the canals with suitable obturaing material.

The main objective of endodontic treatment is total elimination of
microorgansims from the root canal, and the prevention of
subsequent reinfection. This is achieved by careful cleaning and
shaping followed by the complete obturation of the canal space.
The ultimate goal of endodontic obturation has remained the
same for the past 50 years: to create a fluid-tight seal along the
length of the root canal system, from the coronal opening to the
apical termination.

GOALS OF OBTURATION
Fill the entire root canal system & complexities completely as
closely as possible with a suitable obturating materials.
Filling the root canal with a material that will resorb & give way for
the eruption of the permanent tooth.
Developmental, anatomical & physiological differences between
primary & permanent teeth call for differences in criteria for root
canal filing materials.

CRITERIA FOR AN IDEAL PULPECTOMY OBTURANTS
(Rifkin)
• Resorbability
• Antiseptic property
• Non-inflammatory and nonirritating to the underlying permanent
tooth germ
• Radio-opacity for visualization on radiographs
• Ease of insertion and
• Ease of removal
However, none of the currently available obturating materials meet
all of these criterias.
Rifkin A . The root canal treatment of abscessed pri1. mary teeth: A three to four
year follow-up. J Dent Child 1982; 49: 428-431.

VARIOUS ROOT CANAL OBTURATING MATERIALS FOR
PRIMARY TEETH
Most commonly used materials for primary root canal fillings are
Iodoform based pastes
Walcoff paste
KRI paste
Maisto paste
Vitapex/metapex
Endoflas
Zinc oxide Eugenol
Calcium hydroxide
Sealapex
Calcicur
vitapex

Zinc oxide Eugenol
Zinc oxide Eugenol is one of the most widely used materials for
root canal filling of primary teeth.
Bonastre (1837) discovered zinc oxide Eugenol and it was
subsequently used in dentistry by Chisholm (1876).
Zinc oxide Eugenol paste was the first root canal filling material to
be recommended for primary teeth, as described by Sweet in
1930.
It was the only material explicitly recommended in the clinical
guidelines developed by the AAPD untill 2008.
Praveen P, Anantharaj A, Karthik V, Pratibha R. A review of the obturating
material for primary teeth. SRM university journal of dental science 2011;1(3).

Usually a thin mix of ZOE is made, a consistency in which the material
can flow easily (it may allow the material to push beyond the apex).
But if thick paste is used, it leads to underfilled canals ( to avoid this
pressure syringe technique can be used, which was introduced by
camp in 1984)
ZOE without any catalyst allows a longer working time for filling of
canals.

ZOE ADVANTAGES
Excellent antibacterial & analgesic effects (in lower concentrations)
Radiopaque for good radiographic visibility
Easy to manipulate & fill in the canals
Insoluble in tissue fluids
Easily available
Cost effective
No tooth discolouration

ZOE DISADVANTAGES
Rate of resorption of material does not coincide with that of root, is
slower in resorption
When pushed beyond the canals, it irritates the periapical tissue
Is said to show foreign body reaction in contact with periapical tissue
(necrosis of bone & cementum)
The excessive material is retained for years even after exfoliation of the
primary tooth & is shown to harm the permanent tooth bud, forms a
fibrous capsule & alters the path of eruption
Hashieh I A, Ponnmel L, Camps J . Concentration of 3. Eugenol apically released from ZnO E
based sealers. JOE 1999; 22(11): 713-715.

REVIEW OF LITERATURE
Hashieh studied the beneficial effects of eugenol.
The amount of eugenol released in the periapical zone immediately
after placement was10–4 and falls to 10-6 after 24 hrs, reaching zero
after one month. Within these concentrations eugenol is said to have
anti-inflammatory and analgesic properties that are very useful after
a pulpectomy procedure.
Hashieh I A, Ponnmel L, Camps J . Concentration of 3. Eugenol apically released
from ZnO E based sealers. JOE 1999; 22(11): 713-715.

Colla J (1985) found that zinc oxide may alter the path of eruption of
succedaneous permanent.
Erasquin (1967) reported occurrence of necrosis of cementum,
bone and inflammation of periapical tissue.
Colla JA, Sadrian Roya. Predicting pulpectomy success and its relationship to exfoliation and
succedaneous dentition. AAPD 1996; 18(1): 57-63.
Erasquin J, Muruzabal M. Root canal filling with zinc oxide Eugenol in the rat molar. OOO
1967; 24: 547-558.

Robin L W studied unresorbed zinc oxide Eugenol was surrounded
by several layers of condensed cellular tissues. This was composed
of inner layer of tightly packed cells and outer layer of fibroblast
with chronic inflammatory cells.
Coll and Sadrian (1996) reported anterior cross-bite, palatal
eruption, and ectopic eruption of the succedaneous tooth following
ZOE pulpectomy where fragments are left.
Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation
and succedaneous dentition. Pediatr Dent. (1996). 18: 57–63.

Success rates were reported after obturating with Zinc Oxide
Eugenol by various authors as follows –
82.3%- Barr et al.
82.5% - Gould
86.1% - Coll et al. average being 83%
Barr ES, Flaitz CM, Hicks JM , A retrospective radio4. graphic evaluation of primary
molar pulpectomies. PD1991; 13(1): 4-9.
Gould JM . Root canal therapy for infected primary 5. molar teeth: preliminary
report. J Dent Child 1972; 39: 269-73.
Coll J A, Josell S and Casper JS . Evaluation of a one-appointment formocresol
pulpectomy technique for primary molars. Pediatr. Dent 1985; 7(2): 123-129

ZOE & combinations
To improve properties and success rate zinc oxide eugenol in
combination with different components like formocresol,
formaldehyde and paraformaldehyde and cresol have been tried out,
but the addition of these compounds neither increased the success
rate nor made the material more resorbable as compared to zinc
oxide eugenol alone.
Goerig AC, Camp JH. Root canal treatment in primary teeth: a review. Pediatr Dent 1983; 5:
33-37
Goodman JR . Endodontic treatment for children. Br. Dent J 1985; 158: 363-366.

A study was conducted in which iodoformized zinc oxide-eugenol
was tested for its antibacterial effect against the aerobic and
anaerobic bacteria obtained from the root canals of deciduous
teeth and was found to be effective for both the aerobic and
anaerobic bacteria with maximum sustaining period of 10 days.
Garcia- Godoy.F . Evaluation of an Iodoform paste in 9. root canal therapy for infected
primary teeth. J Dent Child 1987; 54: 30-34.

A combination of zinc oxide powder and calcium hydroxide paste for
obturation of primary teeth has shown that the obturated material
remained up to the apex of root canals till the beginning of
physiologic root resorption. Also the material was found to resorb at
the same rate as teeth.
Chawla HS, Mathur VP, Gauba K, Goyal A. A mixture of Calcium Hydroxide and Zinc Oxide
as a root canal filling material for primary teeth: a preliminary study. J Indian Soc Pedo
Prev Dent 2001; 19 (3): 107-109.

A combination of calcium hydroxide, zinc oxide, and 10% sodium
fluoride solution has been tested for the rate of resorption and
the mixture was quite similar to the rate of physiologic root
resorption in primary teeth.
Chawla HS, Setia S, Gupta N, Gauba K, Goyal A, 11. Evaluation of a mixture of zinc
oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for

IODOFORM BASED PASTE
WALCOFF
PASTE
Parachlorophenol
Camphor
menthol
KRI PASTE
Parachlorophenol
Camphor
Menthol
Iodoform
MAISTO PASTE
Parachlorophenol
Camphor
Menthol
Iodoform
Zinc oxide
Thymol
Lanolin
VITAPEX/METAPEX
Calcium hydroxide
Iodoform
Oily additives

ENDOFLAS
Iodoform
Zinc oxide
Calcium hydroxide
Barium sulfate
Eugenol
Paramonochlorophenol GUEDES-PINTO PASTE
Rifocort
Champhorated
paracholorophenol
Iodoform

IODOFORM PASTES
IODOFORM
• It is a prepartion of iodine
• Obtained by action of chlorinated lime upon an alcoholic solution of
potassium iodide heated at 1040 degree F.
• No irritant action
• Relieves pain, and is a potent disinfectant
• Better resorbability and disinfectant properties than ZOE
• But they may produce a yellowish brown discoloration of the tooth

WALCOFF PASTE
Parachlorophenol 4-8%
Camphor
Menthol crystals 1.40-2.90%
Eugenol 22-24%
Zinc oxide 48-58%
Thymol 12-18%
Silver powder 0.70-1.45%

PARACHLOROPHENOL
Antiseptic agent
Dissolve albumins and which can therefore progressively penetrate
into the canaliculi of the tooth
CAMPHOR
To allay the pain arising from the near exposure of the pulps
of teeth, also the pain of sensitive dentine.
Also to arrest the hemorrhage

MENTHOL
Anodyne
Antispasmodic
Antiseptic
Menthol has given satisfation as an external remedy in facial
neuralgia, odontalgia, as an obtunder of sensitive dentine as a local
anesthetic
WALCOFF PASTE DISADVANTAGES
Total resorption, which occurs both in the periapical area and in the
canal area of the tooth

KRI PASTE
Relieves pain
Potent disinfectant
arrest the hemorrhage
Allays pain of wounded pulp of teeth
Anodyne
Antispasmodic
antiseptic
Disinfects root canal
Treating periapical infections
Iodoform Camphor
Menthol Parachlorophenol

•KRI paste resorbs rapidly & has no undesirable effects on
succedaneous teeth.
•Also used as a root canal medicament in abscessed primary teeth
with no harmful effects
•Rate of resorption of the extruded material is faster than the tooth
root,,ometimes the material also resorbed inside the canal
•Has long lasting bactericidal potential
•Does not set into hard mass & can be removed if retreament is
required

• Fuks AB et al in 2000 found that the success rates of 84% with KRI
paste group verus 65% with ZOE group
• Overfills more successfull KRI paste 79% versus ZOE 41%. The excess
paste will resorb without causing any adverse side effects.

Castagnola and Orley (1952) stated that KRI paste loses only 20% of
its potency in 10 years.
Garcia Godoy (1987) found that KRI paste resorbs from the apical
tissue in a week or two; it does not set to a hard mass and can be
inserted and removed easily.
Castagnola L, Orlay HG. Treatment of gangrene of the pulp by walkhoff method. Brit dent J
1952; 93: 93-102.
Garcia Godoy F. Evaluation of an iodoform paste in root canal therapy for infected primary
teeth. JDC 1987; 54:30-34.

MAISTO PASTE
An iodoform based paste developed by maisto and been used
clinicaly for many years with good results reported.
This paste is known for its comparatively slow rate of resorption when
used as an obturating material for primary teeth.

REVIEW OF LITERATUTE
Fernandes in 1996 compared the efficacy of two obturating
materials, ZOE and maisto paste.
Maisto paste was seen to be superior to ZOE in both clinical and
radiological evaluation, done over a period of 9 months in relation to
bone regeneration,healing of inter radicular pathology and resorption
of excess material.

Eliyahu Mass (1989) found Maisto paste to be successful in infected
posterior primary teeth and had positive healing effect on
periradicular tissue.
Mass E, Zilberman LU. Endodontic treatment of infected primary molar using
Maisto paste. JDC 1989; 56:117-120.
Studies have shown these iodoform combinations has been shown
to be bactericidal, resorbable and harmless to the permanent tooth
germs as well as easy to remove.
Barr ES, Flaitz CM, Hicks JM , A retrospective radiographic evaluation of primary
molar pulpectomies. PD1991; 13(1): 4-9.

Pabla et al. (1997)evaluated the antimicrobial efficacy of zinc oxide
Eugenol, Iodoform paste, KRI paste, Maisto paste and Vitapex
against aerobic and anaerobic bacteria obtained from infected non-
vital primary anterior teeth. Maisto paste had the best antibacterial
activity.
Iodoform paste was the second best followed by zinc oxide Eugenol
paste. Vitapex showed the least antibacterial activity.
Pabla T, Gulati MS, Mohan U. Evaluation of antimicrobial efficacy of various root
canal filling materials for primary teeth. J Indian Soc Pedod Prev Dent. 1997;
15(4):134-40.

VITAPEX/METAPEX
•Vitapex have been published by Fuchino and Nishino (1980).
•Vitapex that contains Calcium hydroxide and iodoform along with
silicone oily base (additive)
•Iodoform 40.4%, Calcium hydroxide 30.3%, and Silicone 22.4%.
•A lot of researchers considered this mixture as nearly an ideal root
canal filling material for primary tooth,owing to its excellent
properties.

The iodoform is a known bactericide that is released from the sealer
and suppresses any residual bacteria in the canal or periapical
region.
calcium hydroxide has a biocompatible antibacterial activity,
induction of mineralized tissue formation , activation of alkaline
phosphatase and collagen synthesis and ability to produce
hydrolysis of bacterial endotoxin.
Garcia-Godoy. Evaluation of an iodoform paste in root canal therapy for infected
primary teeth. Journal of Dentistry for children. (1987). 54: 30–4.

ADVANTAGES
• Has no toxic effects on the permanent successor tooth
• Good antiseptic action
• Adheres well to the canal walls
• It does not set to a hard mass
• Resorption occurs at a slightly faster rate then the roots, complete
resorption of the excess paste is expected within 2-8 weeks.
• Ease of applicability of the material
• Is radiopaque, so better radiographic visibility

DISADVANTAGES
• Iodoform-based material though resorbs if pushed beyond the
apex however the rate of resorption is faster than the roots.
• Causes discoloration of the teeth.
• The rapid elimination of iodoform by the organism leaves behind
empty spaces inside the root canal, which may undermine the
success of the endodontic therapy.
Cerqueira DF, Mello-Moura AC, Santos EM, Guedes-Pinto AC. Cytotoxicity histopathological,
microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric
dentistry: a review. J Clin Pediatr Dent. (2008). 32: 105–10.
Nurko C, Garcia Godoy F. Evaluation of a calcium hydroxide/iodoform paste (Vitapex) in root
canal therapy for primary teeth. J Clin Pediatr Dent. (1999). 23: 289–94.

Nurko et al.(1983) said that vitapex as success rate of 96 to 100% when
extruded into furcal or apical area.
the use of iodine-based materials in contact with live tissues has no
longer been indicated because of their potential for causing toxic
side-effects.
Trairatvorakul C (2008)Vitapex appeared to resolve furcation pathology
at a faster rate than zinc oxide-eugenol at 6 months, while at 12
months, both materials yielded similar results
Chawla HS, Mathur VP, Gauba K, Goyal A. A mixture of calcium hydroxide and zinc oxide
as a root canal filling material for primary teeth: a preliminary study. ISPPD. (2001). 19: 107–9.

ENDOFLAS
Endoflas is a resorbable paste
Obtained by mixing a powder containing
Iodoform,
Zinc Oxide (56.5%),
Calcium Hydroxide (1.07%),
Tri-iodomethane Dibutilorthocresol (40.6%),
Barium Sulphate (1.63%) And
 Liquid Consisting Of Eugenol And Paramonochlorophenol.

ADVANTAGES
The material is hydrophilic and can be used in mildly humid canals.
It firmly adheres to the surface of the root canals to provide a good
seal.
Due to its broad spectrum of antibacterial activity, Endoflas has the
ability to disinfect dentinal tubules and difficult to reach accessory
canals that cannot be disinfected or cleansed mechanically.
Unlike other pastes, Endoflas only resorbs when extruded extra-
radicularly, but does not wash out intra-radicularly (Fuks et al 2002)

DISADVANTAGES
Eugenol content can cause periapical irritation.
It also has a drawback of causing tooth discoloration.
Ramar & Murgara (2010) observed a much higher success rate with
Endoflas (95%) compared to other materials and also reported
healing ability, bone regeneration characteristics and resorption of
excess Endoflas without washing within the roots.
Ramar K, Murgara J. Clinical and radiographic evaluation of Pulpectomies using three root
canal filling materials: An in-vivo study. J Indian Soc Pedod Prevent Dent. (Jan/Mar 2010).
28(1): 25–9.

Navit S et al 2016 evaluated the antimicrobial efficacy of obturating
materials against E. faecalis, amongst all the groups Endoflas had
significantly higher zone of inhibition.
Antimicrobial efficacy of various materials according to this study
can be summarized as follows:
Endoflas > ZOE >Calcium hydroxide + Chlorhexidine > Calcium
hydroxide + Iodoform +Distilled water ~ Metapex > Saline.
NAVIT S et al.Antimicrobial Efficacy of Contemporary Obturating Materials used in Primary
Teeth- An In-vitro Study.2016 Journal of Clinical and Diagnostic Research. 2016 Sep, Vol-
10(9): ZC09-ZC12

GUEDES-PINTO PASTE(1981)
Rifocort - Prednisolone Acetate Corticosteroid 5mg(Antiinflammatory )
Rifamycin Sodium Salt (Antibiotic)
Propilenglycol (Vehicle)
Macrogol (Polyethylene-glycol) - Vehicle
Champhorated paracholorophenol - Proportion 3:7
30% Parachlorophenol
70% Camphor
(Antimicrobial+analgesic)
Iodoform – Iodine (Antimicrobial)

Silva CM et al 2002.GPP has both bactericidal and bacteriostatic
effect against S. mutans, S. aureus, E. faecalis and C. Albicans

Chedid et al. 1992 compared, on a histological basis, the effect of two
pulp capping agents (formocresol and GPP) in rat molar pulp after
pulpotomy procedures. In the final period of the experiment (90 days),
teeth treated with the GPP presented complete wound healing and
the formation of a dentinal bridge, while those treated with
formocresol presented a large necrotic area, close to the exposed
coronal pulp and extending to the radicular pulp.

Faraco-Junior and Percinoto (1998) compared the histological effects
of two pulpectomy techniques (using the GPP paste and another
paste composed of calcium hydroxide, iodoform and propilenoglycol)
on dog’s teeth, the results after 30 days demonstrated that both
techniques were well tolerated by the periapical tissues; however, the
technique with the GPP displayed higher levels of inflammation and
bone resorption only at the apical region.

Sousa et al.2000 observed the biocompatibility of the GPP,
Calcium hydroxide paste (PA), and CTZ paste placed on “guinea pigs”
bone implants. The morpho-histological analyses were classified based
on the FDI/ADA criteria for inflammation. The results for 30 days
showed severe inflammatory reaction for PA and CTZ paste, while
none, or a mild reaction, was observed for the GPP. After 90 days, the
reactions to PA paste were absent or mild; the CTZ paste, perpetuation
of the inflammatory process showed, ranging from moderate to
severe. Conversely, the GPP was replaced by neoformed bone tissue.

CALCIUM HYDROXIDE
• Calcium hydroxide is a white odourless crystalline powder.
• It has low solubility in water (a good clinical characteristic because
a long period is necessary before it becomes soluble in tissue
fluids when in direct contact with vital tissues.)
• It has high pH about 12.5

Leonardo et al in 1982 recommended the addition of other
substances to the paste
• To maintain the paste consistency of the material which does not
harden on set.
• To improve flow
• To maintain the high pH of calcium hydroxide
• To improve radiopacity
• To make clinical use easier

ADVANTAGES
This material was found to be easy to apply.
Resorbs at a slightly faster rate than that of the root.
It has no toxic effects on permanent successor.
Radiopaque.

DISADVANTAGES
• Pulp obliteration due to osteogenic potential, it is capable of inducing
calcific metamorphosis, thereby obliterating the root canals.
• Induces internal resorption in primary teeth due to the over
stimulation of the undiferentiated mesenchymal cells thus inducing
odontoclast causing resorption of dentin.
• Lack of adhesion to the hard tissue, leading to inadequate seal
against microleakage resulting in bacterial access to plup
• Tendency to get depleted from the canal
• Resorbs earlier than the physiological resorption of the roots.

Pitts 1984 studied the absorbable nature of Calcium Hydroxide. He
found that significant wash out of apical plugs of Calcium Hydroxide
occurred during the first month after placement. By the ninth month,
plugs were virtually gone from the apical portion of the root canal.
Adjacent to remaining Calcium Hydroxide particles, giant cells but no
inflammatory cells were seen.
Poor success rates were reported due to high occurrence of internal
resorption by Via and Shroeder.
Pitts . A histologic comparison of Calcium Hydrox13. ide plugs and dentin plugs used for the
control of GP root canal filling materials. JOE 1984; 10: 283-293.
Via WF. Evaluation of decidous molars treated by 14. pulpotomy and Calcium Hydroxide. Jou Am
Dent Assoc 1955; 5: 34-43.
Schroder U . A 2-yr follow up of primary molar, pul15. potomized with a gentle technique and
capped with Calcium Hydroxide. Scand J Dent Res 1978; 86: 273-278

• Clinical Studies have reported a success rate of 80 to 90% with this
material as an obturant.
• Heithers in 1975 reported that Ca(OH)2 can be used as a root canal
dressing in teeth with large periapical lesions and in cases where it
was necessary to control the passage of periapical exudates into the
canal.
• Matsumiya and kitanuma 1960 considered that Ca(OH)2 accelerated
the natural healing of periapical lesions, regardless of the bacterial
statics of root canal at the time of placement of material.

CALEN PASTE
•A calcium hydroxide-based paste
•Calen paste exhibited biocompatibility , high antimicrobial activity
and satisfactory clinical, radiographic outcomes & intermediate
setting time values.
•The mean initial pH was 6.1, and it exhibited a progressive increase
until reaching a peak at the five-hour time point with mean ph value
of 8.4
•High registration levels, which indicate high radiopacity.
•Showed a lower solubility compared with the other groups

CTZ PASTE
CTZ is an antibiotic paste
Comibation of chloramphenicol 500mg+tetracycline 500mg+zinc oxide
1000mg+ eugenol 1 drop
Chloramphenicol is an antimicrobial agent that acts against a large
number of aerobic, facultative anaerobe and spirochetes as well as
gram +ve and gram –ve microorganisms.
Tetracycline is a broad spectrum antibiotic, which can be bactericidal at
high conc. Offer excellent effectiveness against gram –ve bacteria and
all anaerobes

ZOE provides analgesic properties and potent antibacterial action
against staphylococcus, micrococci, bacillus and enterobacteria for
more than 30 days.
ADVANTAGES
Application technique is easy, simple
Has antibacterial power
Promotes stabilization of bone resorbtion
Does not cause tissue sensitivity
Does not produce damage to the permanent tooth in
developement
DISADVANTAGES
Pigmentation of the crown of the treated tooth

COLLA COTE
• It is a soft white pliable biocompatible sponge obtained from bovine
collagen
• It can be applied to moist or bleeding canals
• Its an absorbable collagen barrier which prevents or diminishes
extravasation of root canal filling material during primary molar
pulpectomies.
• Also can be used as a scaffold for bone growth and so can be
applied on the wounds.

ROLE OF COLLA COTE
•Physiological and pathological resorptive process change the position
of the apical foramen almost continuously.
•Bleeding from periapex makes obturation difficult, colla cote can be
used as an apical stop, or barrier over which obturant can be filled.
•Colla cote is widely used in endodontic therapy. When left inside a
periapical defect, colla cote gradually resorbs providing a scaffold for
bone deposition and growth.

FRANK’S PASTE
•Combination of calcium hydroxide + champhorated
parachlorophenol
•It is well tolerated by adjacent periapical tissue without any
inflammation & with deposition of osteodentin

Comparison of various materials according to different
studies
Sunitha B et al 2014 conducted a study to check the
Resorption of Extruded Obturating Material in Primary Teeth.
Materials are zinc oxide eugenol (ZOE), iodoform,Vitapex, calcium
hydroxide, and Endoflas.
Conclusion
ZOE is gold standard obturating material in primary but it is not
indicated in the resorbed roots, calcium hydroxide and Endoflas are
recommended are easily resorbed even though it is extruded.

Fidalgo FB et al 2010 A Systematic Review of Root Canal Filling
Materials for Deciduous Teeth: Is There an Alternative for Zinc
Oxide-Eugenol?
Materials iodoform paste with calcium hydroxide (IP + Ca) and ZOE
IP+ Ca performed better than ZOE.
There seems to be no convincing evidence to support the superiority
of any material over ZOE, and both ZOE and IP + Ca appear to be
suitable as root canal fillings for deciduous teeth.

SILVA et al 2010 Histopathological Evaluation of Root Canal Filling
Materials for Primary Teeth
Group I: calcium hydroxide and polyethylene glycol-based paste
(Calen) thickened with zinc oxide;
Group II: paste composed of iodoform, Rifocort® and camphorated
paramonochlorophenol
Group III: zinc oxide-eugenol cement
Group IV: sterile saline.
On the basis of the histopathological parameters examined and
considering the evaluated materials the Calen paste yielded the best
tissue response, being the most indicated material for root canal filling
of primary teeth with pulp vitality.

Group II the presence of camphorated paramonochlorophenol, the
most cytotoxic component of the paste, which could be responsible
for the reduced number of fibers, fibroblasts and vessels observed in
the periapical region of the specimens.
Group III The root canals filled with zinc oxide-eugenol cement
showed an adverse tissue response, which included the presence of
inflammatory cells, edema and severely thickened periodontal
ligament
Group IV Mild inflammatory cells infiltrate, periodontal ligament with
normal thickness and absent resorption of mineralized tissues were
observed

Reddy S, et al 2008 Evaluation of antimicrobial efficacy of various
root canal filling material used in primay teeth.
Materials Zinc oxide-Eugenol and Formocresol (ZOE+FC),
Calcium hydroxide and sterile water (CAOH+H2O),
Zinc oxide and Camphorated phenol (ZO+CP),
Calcium hydroxide and Iodoform (Metapex) and
Vaseline (Control),
anti-microbial efficacy of ZOE+FC produced strong inhibition against
most bacteria when compared to ZOE, ZO+CP and CAOH+H2O.
Metapex and Vaseline were found to be non inhibitory.
.

HERBAL OBTURANTS
ALOE VERA (Aloe barbadensis)
The chemical constituents present in them are part of the
physiological functions of living flora, and hence, they are believed to
have better compatibility with the human body.
Aloe vera can be used for various therapeutic as well as preventive
purposes owing to its anti-inflammatory, antibacterial, antifungal,
antiviral, moisturizing, and pain-relieving properties.
Because of these properties that are useful in dentistry, aloe vera gel
can be also used in any obturating medium for therapeutic purposes.

zinc oxide powder, if mixed with aloe vera gel, provides the following
advantages:
it does not set,
its ease of placement,
easily retrievable nature, etc.
So, Khairwa A et al in 2014 in their study they have used zinc oxide
powder with aloe vera gel to check the efficacy of this combination as
an obturating material for primary teeth.
Results it can be observed that endodontic treatment using a
mixture of zinc oxide powder and aloe vera gel in primary teeth has
shown good clinical and radiographic success.

TULSI (OCIMUM SANCTUM)
•Jaidka S et al in 2014 The antimicrobial efficacy of obturating materials
used in primary teeth was evaluated against E. Faecalis
•Materials zinc oxide eugenol, zinc oxide with tulsi extract and zinc
oxide with aloe vera as obturating materials.
•Intergroup comparison revealed significant difference amongst all the
groups except between zinc oxide eugenol and zinc oxide with tulsi
extract. Zinc oxide eugenol had significantly higher zone of inhibition
among all the groups.
•According to results obtained from the present study can be
summarized as follows: Zinc oxide eugenol > Zinc oxide with tulsi
extract > Zinc oxide with aloe vera

RETAINED PRIMARY TEETH
Retained primary teeth without permanent successor present a unique
challenge to the dentist.
These teeth are often prone to caries because of factors such as
• longevity of the tooth in the oral cavity,
• Discrepancies in interproximal contact with permanent teeth and
• Variation in enamel thickness.
Weine FS. Endodontic therapy. 5th ed. St. Louis: Mosby, 1996: 359-61.

Retained deciduous tooth requiring different obturating material that
would not undergo resorption & biocompatible to the retained
primary roots. So, materials used for situation like this are
• Guttapercha,
• Mineral Trioxide Aggregate (MTA), and
• Calcium Enriched Mixture (CEM)
Nagesh B, Naik B, Sarath R K, Lakshmi D V. Obtuation of retained primary mandibular seond
molar with missing successor with Gutta-percha: A case report. JIDA, Vol. 5, No. 2, February
2011
Kokich VG, Kokich VO. Congenitally missing mandibular second premolars: Clinical options.
Am J Orthod Dentofacial Orthop 2006; 130: 437-44.

Guttapercha is a desirable filling material because it is
• Nontoxic,
• Least irritating to periapical tissues,
• Impervious to moisture.
Mineral Trioxide Aggregate (MTA) is recently introduced cement.
Studies have demonstrated cemental repair, formation of bone, and
regeneration of the periodontal ligament when MTA is used.
Howard W Roberts, Jeffrey M. Toth, David W. Berzins, David G. Chartlon. Mineral trioxide
aggregate material use in endodontic treatment: A review of the literature Dental
Materials 2008; 24:149-164.

American Academy of Pediatric Dentistry, “Guideline on pulp
therapy for primary and young permanent teeth,” Pediatric
Dentistry, vol. 27, no. 7, pp. 130–134, 2005.
F. Garcia-Godoy. Evaluation of an iodoform paste in roo canal
therapy for infected primary teeth. ASDC Journal of Dentistry for
Children 1987; 54(1): 30-34.
M. Mortazavi and M. Mesbahi. Comparison of zinc oxide and
eugenol, and Vitapex for root canal treatment of necrotic primary
teeth. International Journal of Paediatric Dentistry 2004;
14(6):417-424.

1) Action of camphor in KRI paste
a. Arrests hemorrage
b. Anodyne
c. Relieves pain
d. antimicribial
2) Calen paste is a combination of
a. Ca(OH)2+ZO+polyethylene glycol
b. Ca(OH)2+ZO+ iodoform
c. Ca(OH)2+ZO+ CMCP
d. Ca(OH)2+ZO

3) Who recommended the addition of other substances to the
Ca(OH)2 paste to improve its properties
a. Leonardo in 1982
b. Fuks in 1982
c. Sweet in 1982
d. Colla J in 1982
4) Main disadvantage of iodoform based paste
a. Resorption
b. Tooth discolouration
c. Inflammation to periapical tissues
d. solubility

5) Which material has both bactericidal and bacteriostatic effect
against S. Mutans
a. Guedus pinto paste
b. CTZ paste
c. ZOE+Ca(OH)2
d. Calen paste

Obturating materials for primary tooth

More Related Content

What's hot (20)

Similar to Obturating materials for primary tooth (20)

Recently uploaded (20)

Obturating materials for primary tooth