Reinforced Zinc Oxide-eugenol Cement Research Articles

Long-term Outcomes of Full Pulpotomy in Permanent Molars for Patients Treated in a Single, Short Session under Special Conditions

IntroductionEndodontic procedures for patients requiring treatment in a single, short session need to be validated. This study aimed at evaluating the long-term outcome of full pulpotomy in permanent molars performed with reinforced zinc oxide–eugenol cement (Intermediate Restorative Material [IRM], Dentsply Sirona, Versailles, France) immediately restored using stainless steel crowns under general anesthesia. MethodsThe absence of clinical signs and symptoms and the evolution of the periapical index between the treatment date and the longest follow-up time were used to grade the pulpotomy outcome as “effective,” “uncertain,” or “ineffective.” The impact of different criteria on the pulpotomy outcome was tested (ie, the etiology of the lesion, tooth maturity, endodontic difficulty related to the coronal shape and the root canal shape, and endodontic difficulty related to the radiographic root canal appearance). ResultsAmong the 608 teeth (338 patients) treated in a single session with IRM full pulpotomy and stainless steel preformed crowns, 263 (143 patients) were evaluated after a median follow-up period of 24 months. Overall, 89% of the pulpotomies were effective, 7.6% were of uncertain outcome, and 3.4% were ineffective. No tested criteria influenced the rate of effectiveness. ConclusionsLong-term outcomes of IRM pulpotomy are similar to those of calcium silicate–based cement pulpotomy observed in the literature. This procedure should not be restricted to patients treated under general anesthesia because it is relevant for all special conditions that impose the provision of endodontic treatment in a single, short session, such as dental care emergencies during humanitarian crises or pandemic periods.

Cytotoxicity of Newly Developed Ortho MTA Root-end Filling Materials

IntroductionVarious materials have been advocated for use as root-end filling materials. The purpose of the present in vitro study was to compare the cytotoxicity of 4 root-end filling materials: glass ionomer cement (GIC; Fuji II, GC Corp, Tokyo, Japan), reinforced zinc oxide–eugenol cement (IRM; Dentsply Tulsa Dental, Tulsa, OK), and 2 types of mineral trioxide aggregate. MethodsThis study used MG-63 cells derived from a human osteosarcoma. To quantitatively evaluate the cytotoxicity of test materials, the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay was used. The cells were exposed to the extracts and incubated. Cell viability was recorded by measuring the optical density of each test well in reference to controls. Each specimen was examined by scanning electron microscopy for the observation of cell morphology. ResultsThe XTT assay showed that the cell viability of ProRoot MTA (Dentsply Tulsa Dental) was higher than that of GIC and Ortho MTA (BioMTA, Seoul, Republic of Korea) at all time points. IRM showed significantly lower cell viability than the other groups. The scanning electron microscopic analysis revealed that elongated, dense, and almost confluent cells were observed in the cultures of GIC, Ortho MTA, and ProRoot MTA specimens. In contrast, cells on the surface of IRM were rounded in shape, and the numbers and the density of the cells were smaller than that in the other groups. ConclusionsProRoot MTA and GIC showed good biocompatibility in this study. However, Ortho MTA showed lower biocompatibility compared with ProRoot MTA and GIC.

Effect of tooth whitening on dental restorative materials

ObjectiveTo evaluate the effects of tooth whitening with 10% carbamide peroxide on the surface ultramorphology of three dental restorative materials. Materials and methodsThree materials were tested: (1) a reinforced zinc oxide-eugenol cement (IRM® Powder Zinc Oxide Eugenol, Dentsply, Konstanz, Germany), (2) a high copper amalgam with spherical particles (Ventura Finest®, Madespa SA, Toledo, Spain) and (3) a nanohybrid composite (EvoCeram Tetric®, Ivoclar Vivadent AG, Schaan, Liechtenstein). 6 specimens of each material (N=18) were inserted into silicone molds with circular cavities of 10mm×2mm. 3 specimens of each material were randomly assigned into the whitening or control groups. In the whitening group, the specimens were exposed to a 10% carbamide peroxide gel (Opalescence® PF 10%, Ultradent, South Jordan, UT, USA) for 14 consecutive days, 6h per day. In the control group, the specimens were exposed to distilled water. After 14 days stored at 37°C, all specimens were analyzed by scanning electron microscopy. ResultsThe specimens exposed to carbamide peroxide revealed an irregular surface, with cracks and pores. Specimens from all control groups showed a smooth surface. ConclusionThe 10% carbamide peroxide gel may cause changes in surface ultramorphology of the materials tested: reinforced zinc oxide-eugenol cement, amalgam and composite.

Healing of experimental apical periodontitis after apicoectomy using different sealing materials on the resected root end

This study evaluated apical periodontal healing after root-end sealing using 4-META/MMA-TBB resin (SB), and root-end filling using reinforced zinc oxide eugenol cement (EBA) or mineral trioxide aggregate (MTA) when root canal infection persisted. Apical periodontitis was induced in mandibular premolars of beagles by contaminating the root canals with dental plaque. After 1 month, in the SB group, SB was applied to the resected surface following apicoectomy. In the EBA and MTA groups, a root-end cavity was prepared and filled with EBA or MTA. In the control group, the root-end was not filled. Fourteen weeks after surgery, histological and radiographic analyses in a beagle model were performed. The bone defect area in the SB, EBA and MTA groups was significantly smaller than that in the control group. The result indicated that root-end sealing using SB and root-end filling using EBA or MTA are significantly better than control.

Case Report: Dental Treatment of a Child with Hypophosphataemic Rickets

Background: Hypophosphataemic rickets is an hereditary metabolic disease characterised by osseous and dental structural defects. The oral manifestations include highly frequent pulp infections as a result of enamel and dentinal defects. The pulp infections are multiple, spontaneous and can occur from an early age, becoming, in some cases, the first signs of the disease. An early preventive treatment is essential for a good oral health of these patients. Case report: The purpose of this case report was to illustrate the dental repercussions of hypophosphataemic rickets in a five-year-old child. Intraoral examination showed a complete primary dentition and two fistulae at the labial periapical region of teeth 51 and 61. Bitewing radiographs revealed multiple interproximal caries of the primary molars. Pulp chambers were enlarged, with pulp horns extending to the dentino-enamel junction. Treatment: Quadrant dentistry with rubber dam isolation was carried out. Pulpotomies were performed with ferric sulphate and reinforced zinc-oxide eugenol cement on the entry of the radicular canals. For all teeth, after pulpotomy, complete haemostasis was achieved, suggesting healthy pulps. Molars were restored with pre-formed metal crowns cemented with glass ionomer cement. For canines, after pulpotomy, a glass ionomer base and a composite resin was used. Follow-up: At six-month follow-up unsuccessful multiple pulpotomies (55, 75, 85, 74, and 63) were noted. Clinically there were abscesses on 55 and 63 and pulpectomies will now be needed, but the prognosis remains unclear

Chemical Modification of ProRoot MTA to Improve Handling Characteristics and Decrease Setting Time

Mineral trioxide aggregate (MTA) fulfills many of the ideal properties of a root-end filling material. However, the composition of this material often makes MTA difficult to use, a direct result of its granular consistency, slow setting time, and initial looseness. Additives used by the Portland cement (PC) industry to increase PC's plasticity and decrease its setting time were added first to PC and then to gray MTA in an attempt to improve MTA's handling characteristics, with the combination providing the best handling characteristics tested for its effect on compressive strength (for changes in the original material's properties) and decrease in setting time. An admix of 1% methylcellulose and 2% calcium chloride resulted in a mix of chemically modified MTA that, when compared with unmodified MTA, (1) handled similarly to a reinforced zinc oxide-eugenol cement, (2) gave an approximately equal compressive strength, and (3) set one third faster (57 +/- 3 minutes).

In vitro comparison of three materials as apical sealants of equine premolar and molar teeth

Surgical endodontic therapy is a conservative dental technique used in horses with some degree of clinical success. Failure of this procedure can partially be explained by inadequate sealing of the root apices with resultant microleakage in the periapical area. To assess and compare in vitro sealing ability of 3 different dental restorative materials used as apical sealants during equine surgical endodontics. Thirty extracted equine cheek teeth were divided randomly into 3 groups and subjected to apicoectomy and apical sealing using 3 materials: reinforced zinc oxide-eugenol cement; intermediate restorative material (IRM); a resin-modified glass ionomer; and amalgam. After apical sealing, the teeth were submerged in a solution of Procion Brilliant Cresyl Blue stain for a period of 7 days. The teeth were then washed, embedded in resin, sectioned and assessed microscopically for dye leakage around the apical restorations. Although the materials proved effective as apical sealants, some dye leakage was encountered in all 3 groups with no statistical difference (P = 0.114). IRM, a resin-modified glass ionomer and amalgam all showed comparative features as apical sealants when used in vitro in equine teeth. IRM is currently regarded as the superior material in clinical situations due to its ease of handling and lesser sensitivity to environmental moisture during placement compared to the other 2 materials.

Sealing ability of MTA, Super EBA, Vitremer and amalgam as root-end filling materials

This study evaluated the root-end sealing ability of mineral trioxide aggregate (MTA Angelus), reinforced zinc oxide-eugenol cement (Super EBA), resin-modified glass ionomer (Vitremer) and zinc-free amalgam (GS-80) (control). The root canals of eighty human lower molars were accessed, cleansed, shaped and obturated. Apexes were resected and cavities were prepared. Teeth were divided into 4 groups of 40 cavities, root-end filled with the materials, and immersed in methylene blue for 72 h at 37 degrees C. Roots were then sectioned transversally at each millimeter and evaluated under magnification, observing the dye penetration in each section. Data were evaluated using Kruskal-Wallis test at a 5% level of significance, showing the differences among all materials (p < 0.001). The crescent order of microleakage was MTA < Vitremer < Super EBA < amalgam. Higher leakage levels were observed in the first millimeter sections of amalgam, Vitremer and MTA, when compared with the third millimeter section (p < 0.05).

Long-term Durability of Root-end Sealing with 4-META/MMA-TBB Resin

The purpose of this study was to compare root-end sealing using 4-META/MMA-TBB resin with that using conventional retrograde root filling technique, and thereby determine if 4-META/MMA-TBB resin offers long-term prevention against dye leakage from the root canal of human teeth. Thirty-five teeth had the apical 2.5 mm of the root resected. In the Sealing (SB) group, 4-META/MMA-TBB resin was applied to the resected surface. In the Filling (Am and EBA) groups, a root-end cavity was prepared and retrofilled with high copper amalgam alloy or reinforced zinc oxide-eugenol cement. Root canals were filled with methylene blue dye solution. Then, dye leakage outside the root canal was measured for 50 weeks. The integrated amount of leakage in SB group was significantly lower than those in Am group (p < 0.05) and EBA group (p < 0.05). Therefore, it can be concluded that root-end sealing using 4-META/MMA-TBB resin resulted in better, long-term sealing than conventional retrograde root filling.

Ability of Three Root-End Filling Materials to Prevent Bacterial Leakage

This study evaluated the ability of three materials--a resinous root canal sealer (Sealer 26) prepared in a thick consistence, a reinforced zinc oxide-eugenol cement (IRM), and a glass-ionomer cement (Fuji IX)--in preventing bacterial leakage. Retrofilled teeth were mounted in an apparatus and then challenged by human saliva. The number of days required for the bacteria from saliva to penetrate the root-end filling materials was determined. Evaluation was conducted for 60 days. Leakage was observed in all teeth of the Fuji IX group, and in 95% (19 of 20 specimens) of the teeth retrofilled with IRM. Sixty-five percent (13 of 20 teeth) of the teeth retrofilled with Sealer 26 showed leakage. No difference was detected between Fuji IX and IRM (p > 0.05). However Sealer 26 was significantly more effective in preventing bacterial leakage when compared with other materials tested (p < 0.05).

Reaction of bony tissue to implanted silver glass ionomer and a reinforced zinc oxide-eugenol cement

To evaluate the tissue responses to implants of Ketac Silver and Super EBA cement in the guinea pig mandible. Sixteen guinea pigs were used for 2 experimental periods of 4 and 12 weeks. Both materials were placed in Teflon applicators and implanted into surgically prepared sites in the mandible. A histologic examination for reaction to the material occurred after the animals were killed and processed. After 4 weeks, minimal inflammatory reactions were observed in Ketac Silver implants, whereas the Super EBA implants showed minimal to moderate inflammation. Localized foreign body reaction was present in areas of fragmented small particles of Ketac Silver. At 12-weeks observation, no inflammatory reactions were present around either material. Direct bone contact was observed in 1 Ketac Silver implant. Ketac Silver and Super EBA cement elicited mild reactions under the conditions of this model. From a biologic point of view, these 2 materials may offer equal utility in endodontic surgery.

Tissue response to potential root-end filling materials in inflected root canals

The tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol) were compared with that to amalgam. In 27 premolar teeth of beagle dogs (54 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periapical lesions. On each root, an apicectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 8 weeks (24 roots) and 4 weeks (30 roots); and they were prepared for histological examination. The tissue response to amalgam fillings after 4 and 8 weeks was marked by moderate or severe inflammation on all roots, and extended > 0.5 mm in 10 out of 18 roots. In contrast, after 8 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation while the tissue response to Vitrebond was the best of the three materials, and was also less extensive. After 4 weeks, the overall best tissue response was with Kalzinol, followed closely by Vitrebond. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were statistically significant (P < 0.01). Similarly, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Both Vitrebond and Kalzinol have potential as root-end filling materials as the tissue response was considerably more favourable than that to amalgam.

Retrograde root filling with EBA cement or amalgam: A comparative clinical study

This article presents a comparative clinical study of reinforced zinc oxide eugenol (EBA) cement and amalgam used as retrograde root filling materials. All patients were followed for a minimum of 3 years after surgery. Clinical and radiographic evaluation was performed. Successful healing with complete bone regeneration was noted in 57% in the reinforced zinc oxide eugenol group compared with 52% in the amalgam group. Uncertain healing with a certain degree of bone regeneration was seen in 24% in the reinforced zinc oxide eugenol group compared with 19% in the amalgam group. Unsuccessful healing with failure of bone regeneration was seen in 20% in the reinforced zinc oxide eugenol group compared with 29% in the amalgam group. Statistical analysis failed to show any significant difference in healing between the two retrograde filling materials. The results of this study indicate that retrograde root filling with reinforced zinc oxide eugenol cement has a similar prognosis as with amalgam over a 3-year period.

Microleakage of intermediate restorative materials

This study compares the microleakage of a glass ionomer cement, Ketac Fil, used without cavity conditioning, with the established intermediate restorative materials, Cavit-W, and a reinforced zinc oxide-eugenol cement, Kalzinol. Microleakage was assessed using an electrochemical technique. At the end of 30 days, the materials tested, listed in decreasing order of microleakage, were Cavit-W, Ketac Fil inserted without cavity conditioning, Kalzinol, and the control group of Ketac Fil inserted into conditioned cavities. There was no significant difference in the microleakage observed in Ketac Fil restorations inserted without cavity conditioning and Kalzinol (p = 0.450), while the differences between the other groups were highly significant (p less than 0.001).

Linear dimensional changes of three luting agents

The linear dimensional changes during setting of a reinforced zinc oxide eugenol cement (Alumina EBA Crown and Bridge Cement), a composite resin cement (Epoxylite 9080 Crown and Bridge Adhesive) and a zinc silico phosphate cement (Fluoro-Thin cement), have been studied. The measurements were were performed on specimens placed on a mercury bath. The cements were allowed to set under various environmental humidity. The measurements of specimen length started 3 or 5 min after commencing the mix. The EBA-cement showed a maximum contraction of 0-4 percent after 7 days when setting under dry conditions. Under wet conditions the cement had an initial contraction the first day of setting, and thereafter an expansion. After 21 days specimens setting under 100 percent relative humidity showed 0-3 percent expansion, whereas specimens immersed in water attained the initial length. The composite resin cement showed a contraction of 1-0 percent after 1 day when setting under dry conditions. Under wet conditions the specimens had an initial contraction of 0-8 percent the first day of setting being reduced to 0-4 percent during the next 20 days. The zinc silico phosphate cement showed a maximum contraction of 3-0 percent after 7 days under dry conditions and 0-5 percent after 1 day under wet conditions.

Clinical Study of Dental Cements. VI. A Study of Zinc Phosphate, EBA-Reinforced Zinc Oxide Eugenol and Polyacrylic Acid Cements as Luting Agents in Fixed Prostheses

A clinical trial for the final cementation of crowns and bridges with a reinforced zinc oxide and eugenol cement, a polyacrylic acid cement and a zinc phosphate cement was made over a 3-year period. The study involved 441 patients for whom 547 bridges and 162 single restorations were cemented. The patients were recalled at 6-month intervals for the duration of the study and the restorations were examined for looseness. Of the 547 bridges 520 remained firmly cemented to the abutment teeth. Of 1,082 bridge retainers, 1,049 remained in position; success and failure by types of retainer will be the subject of a subsequent paper. Of the 162 single restorations 159 remained in place.

Clinical studies of dental cements: V. Recall evaluation and a zinc phosphate cement.

Patients with restorations cemented with a reinforced zinc oxide-eugenol cement and a zinc phosphate cement were recalled after a four- to seven-year interval. No significant differences in clinical success were observed between restoration luted with the two cements. No significant difference in the incidence of caries at the restoration margins was noted between the cements.