Bioactive in Endodontics
Bioactive in Endodontics | TOC
The essence of endodontic treatment is to prevent or provide conditions for the resolution of apical periodontitis, which involves partial or complete removal of pulp tissue. But be that as it may – living pulp is the best barrier against bacterial invasion.
On the other hand,
by directly covering the pulp tissue with a certain material, we cannot always guarantee that the result will be predictable, or more effective than pulpectomy. The unpredictability is due to the fact that it’s quite difficult to ensure the elimination of residual bacteria from the tooth hard tissues, and their presence will sooner or later provoke the development of an inflammatory reaction.
It should also be remembered that any sealant does not provide an absolutely complete seal, and sooner or later, microleakage begins to develop at the interface between the material and dentin, which in turn excludes the possibility of forming a dentin bridge.
Also, the quality of the tooth pulp direct coating depends on the completeness of disinfection and cleaning of already affected necrotic tissues.
Progress in biomedicine directly affected dentistry, in particular the possibilities of biological treatment of the pulp. Therefore, in this article we will consider various bioactive dental implants materials that doctors can use in their clinical practice.
The search strategy met the criteria formulated by the National Health Service’s Data Review and Dissemination Center in the United Kingdom. The Medline database was used to select text material. Key words according to MeSH categorization were as follows:
Bioactive and biologically active materials in endodontics. The search was then expanded to collect additional information, including the following databases: Scopus, EBSCOHost, Scirus and Cochrane. The keywords used to search these databases were similar. Links to individual articles have been reviewed to broaden the search for relevant information
Biocompatibility Endodontic Materials
Biocompatibility studies have shown that all endodontic fillers currently used, including gutta-percha (GP), negatively affect the surrounding vital tissues. GP is the most widely used root canal filling material, as animal studies have shown that the material is well tolerated by the body and fibrous tissue forms over time around the gutta-percha particles. However, in the course of clinical studies, the cytotoxic effect of gutta-percha has also been proven, which depends on the size, composition and type of material used. Small GP particles (for example, those formed during the thermal compaction process) can cause an intense local tissue reaction, which can interfere with the healing process of periapical lesions in cases of material excretion from the root apex. Numerous root sealants, such as those made on the basis of epoxy resin, calcium hydroxide and zinc oxide-eugenol, have a pronounced cytotoxic activity and provoke irritation of the surrounding tissues, especially cells in the structure of the periodontal ligament. Eugenol, zinc or formaldehyde derivatives are highly toxic to the periapical space of the tooth.
Thus, in practice, the use of materials with a potential risk of developing cytotoxic, genotoxic, mutagenic or carcinogenic effects should be avoided, since safer analogs can be used as an alternative to them.
Bioactive Materials - Calcium hydroxide
Calcium hydroxide or Ca (OH) 2 has good antibacterial properties and a pH of about 12, which can reduce osteoclastic activity and stimulate bone formation. The alkaline pH level causes the activation of puddle phosphatase, which induces the activity of osteoblast cells. When used as a pulp occluding agent, the hydroxide induces the formation of a dentinal bridge. As a result of the action of hydroxide, fibroblast cells can differentiate and provide the process of dentinogenesis.
Mineral trioxide aggregate (MTA)
MTA was developed in the early 1990s as a material for filling the apex and repairing perforated areas of the lateral surfaces of the Endospace. MTA is mainly made from tricalcium silicate, dicalcium silicate, tricalcium aluminate and tetra-calcium aluminoferrite
Bioactive dentin substitutes
The bioactive dentin substitute, which was developed on the basis of calcium silicate, was first introduced to the market in 2009. This material is suitable for use in cases of closure of perforations, apexification, restoration of restorative defects, when performing a retrograde filling procedure, as well as for direct covering of the tooth pulp.