 Hello everyone, welcome back to another session in dentistry and more Today we have very important topic from endo-tombics that is root repair material. So very frequently asked question From this chapter is retrograde material retrograde filling materials or MTA. MTA is very frequently asked question. So never miss MTA So we have various types of materials such as MTA bio dentine GIC based material, amalgam, vataparcha, zinc oxide, eugenol composites, diacid, biosaramic sealers and recent materials So it is not actually sealants. It is a material Sometimes it is also used as sealants and also a root repairing material or retrograde filling material or regenerative material So every material has got many purposes So to begin with these roots they need repair And they are serious complications in dental practice. Sometimes We might face a condition where the roots are injured Commonly the crowns are getting injured, but sometimes the roots are getting injured and it Pause a number of diagnostic and management problems. So 20th hour of strategic importance root repair is clearly indicated So with 3d imaging technique and illumination Nowadays the scope and success of this root repair is very high. So the common root repair materials are either root end-filling materials after a periapical surgery or perforation repair It might be a accidental perforation or due to any other reason And root regeneration material that could be a biological material or bio active material So root end-filling material They are amalgam gutta-pacha, sincoxide-viginol, dac-related materials composite resins, diacid, mta, bio, dentine And this is a question which was asked In one of the question paper that is a recent materials. What are the recent retrograde material or root end-filling material? That is errm Entosequence bcrrm Bio-aggregate iroot bp plus and novel root end-filling material So we are going to Learn one by one. We'll start with amalgam. Before that we have the The next classification perforation repair material that is mta, bio, dentine Gac, well there in root end-filling material also, so it has got both functions pr is separate that can do prepare of a perforation Whereas root regeneration material that which has the potential to regenerate the lost issues it includes calcium hydroxide mta and bio-dentine are present in all the categories that is perforation And root end-filling whereas a root regeneration material has prp or prf. Those are plasma rich protein So we'll start with amalgam. It is the first choice of root end-filling The biocompatibility of amalgam is cited as a current issue of concern and dentistry because it was the first material The pioneer material Now we have better options than amalgam So many studies have reported that Unfavorable tissue response to amalgam because it is going to be in contact with tissues Usually we place amalgam within the heart tissue that is within the tooth within the enamel dentine But this is going to be in contact with the soft tissues So there are high chances of tissue response with respect to amalgam So the use of amalgam as a root end-filling material can now be confined to history that is its obsolete material which is no longer be used The second one is a gutter butcher which is a commonly used Obturating material So it is also can be used as a root end-filling material because it absorbs moisture from periapacal tissues because of its porous nature Initially it expands but after it contracts in size and very little inflammation it reported The third one that is zinc oxide eugenol cement. So this material was considered to have good handling properties and post-operative results So we are talking about Root end-filling material okay root end-filling material So this original zinc oxide eugenol cement were weak and likely to be absorbed over a period of time So it cannot be kept as a permanent Material at the root end or a root filling material. Therefore it is unsuitable for long-term use So basically two approaches were adopted to overcome this problem That is to improve the physical properties of zinc oxide cement The first one is a substitution of eugenol liquid with eba So eba and the addition of fused quarts or aluminum oxide to the powder So eugenol liquid with eba that is a liquid part and the aluminum oxide to the powder part So it give rise to the super eba cement okay Also The polymeric substance of the powder such as poly methacrylate to the powder It is irm which is a commonly known as intermediate restorative material So super eba and irm are basically zinc oxide eugenol products, but it is modified It has improved Its physical properties. So it can be used as a root canal. So root end-filling material So that was powder to this poly methacrylate to the powder and poly is turning into the liquid Which is known as calcinol. So all our brand names dense play So eugenol is a major cytotoxic component of zinc oxide eugenol cement And the zinc released from this cement is considered to be partly responsible for the cytotoxic effect Now we have the GIC glass anoma cement It is suggested as an alternative root end-filling material But the evidence suggested that there is a cytotoxicity with freshly prepared sample, but it decreases over period So this toxicity decreases as the setting occurs Next we have the composite Resins and other hybrids So this biocompatibility of composite resin is influenced by amount and nature of its leachable components. Okay So the healing of this periradicular tissues to composite is to be very diverse Which ranging from poor to good depending upon the type of material. So we just cannot rely on this composite So basically the Two two materials are used that is retroplastic and jerry store As a root end-filling material. So we know composites been used as a filling material But this is talking about the root end-filling material Now the daquette daquette we have learned in the previous session that was a root The canal sealants sealers So this is also can be used as a root end-filling material. So this is a polyvinyl resin As been advocated as a root end-filling material So when it was used as a root canal sealer by a compatibility studies Show that it was cytotoxic in cell culture And there is a chronic inflammation in osceus and subcutaneous tissues But when it is mixed at the thicker consistency Which can be used as a root end-filling material In that consistency it has shown good biocompatibility with osceus tissues Now the most important one that is a mineral trioxide aggregate or mta So mta was first described by Lee and Mahmoud Tarabinichar In 1993 as a root end-filling material So it is very biocompatible with numerous exciting clinical applications in endotontics So this material appears to be an improvement over other materials That involves root repair and bone healing So this is a composition. It has got powder and a distilled water in the water segment Then tricalcium, dicalcium silicate, tricalcium aluminate, tetricalcium alumina ferrite, calcium sulphate and bismuth oxide So availability of mta This mta is a fine hydrophilic powder available in single-use sachet of 1 gram Some companies also provide pre-measured water sachet for the ease of use Otherwise we need to mix the two components water and powder So the important barrier to the widespread use of mta It's not a very commonly used product by the clinician Why? Because of its cost and difficulty in storage So what is the mechanism of action of mta? So the regeneration of new cement or mta is a unique phenomenon That has not been reported to occur with any other root end filling So this is the only one material or the unique material which shows a new cement formation So this deposition of cementum heart tissue with mta was also seen in Dental repulps apical tissue after this root canal filling So this deposition of cement may be due to the number of factors such as Sealing ability, its biocompatibility or alkaline pH on city So the setting reaction what happens is on hydration the calcium silicates in the powder undergoes hydrolysis when it gets mixed with water and produce Calcium silicate hydrate and calcium hydroxide So about one third of hydration products is constituted by calcium hydroxide which makes mta highly alkaline And it offers biologically active substrate for bone cells and it stimulates interleukinous production When it contacts with this pulp tissue or culture medium produces deposition of this calcite crystals And it was observed that there is rich extracellular network of fibronectin in close contact with these crystals So this is definitely superior to all other root and filling materials such as amalgam, IRM, super eba, in factors such as leakage of methylene blue, fuso bacteria, nucleotide and entotoxin all these can be prevented And it is biocompatible as I mentioned earlier and induces osteogenesis and cementogenesis That is a bone formation and cement formation So which makes it an ideal choice of root repair So this is the best root and filling material So various applications such as it can be used as a pulp capping agent Can be used for root resorption for apexification The furcation problem and the perforation repair and also root and filling So the advantage is it forms an immediate apical barrier over the conventional apexification treatment So it can be achieved in a single appointment That is the most important factor it can be achieved in a single appointment So MTA can be used as a one-step obturation material in an open apex because of this property So the 70 percentage of the failures in study perforation repair were associated with extrusion of the repair material So the material which we are using will definitely extrude to the periapical area And most of the failures that is 70 percentage of failures are due to this problem But when we use MTA it does not have to be compacted as firmly as the other materials like amalgam To adapt adequately to the tooth surface So it will not create that problem Okay, so the setting ability of MTA is uninhibited by blood or water So this is not getting extruded to the periapical area Because it is uninhibited by blood or water so most of the Failure chances are gone So the slow setting time of MTA is an advantage In that it reduces the amount of setting shrinkage Which may help explaining the MTA low micro leakage And the common problem in performing entorontics in immature teeth with necrotic pulp and wide open apex Is obtaining an adequate seal of the root canal system because the root end is not closed So in that cases this MTA will be an excellent product to create an apical plug So that it is sealing the apex This preventing the extrusion of filling material And it has also got antibacterial effect And the low solubility and radio opaque slightly more than that or that of dentine But the main problem with this MTA is MTA dissolves in an acidic phase So when it comes to contact with the oral tissues or oral cavities Oral cavity for an extended period of time There are chances of dissolving And MTA powder has to be mixed with sterile water And we just cannot use with any anaesthetic or sterile liquid This is because the effects other liquids may have on MTAs physical chemical and biological properties So excess moisture has to be removed from the preparation or receptive defect site Because MTA becomes so soapy and difficult to contents And it has got low compressive strength So it cannot be placed in a functional areas The next one is bio dentine So bio dentine was developed by Septodon's research group As a new class of dental material which could Conceal it high mechanical properties with excellent biocompatibility as well as A bio-active behavior So the material is actually formulated using the MTA based cement technology And the improvement of some properties of these types of cement Which has physical qualities and handling So these two properties were lacking in our MTA So the handling properties and the compressive strength So those properties were improved bio dentine So this is our composition Tricalcium, Dicalcium, Silicate, Calcium, Carpinate and Oxide Ion Oxide, Zyconium Oxide Then liquid calcium chloride, Hydro syllable, Polymer Setting time is around 45 minutes The shortest setting time was attributed Due to the addition of calcium chloride in the mixing liquid Compressive strength is higher is due to the Low water cement ratio So it has got many uses such as It can be used for dental Caries, perforations, resorptions, apacal surgery, pulp exposure, pulpitomy and epixification So the material is characterized by the release of calcium when in solution And these tricalcium silicate based material Also defined as a source of high proxy appetite When they are contact with synthetic tissue fluid So another area of use is when we have a repair of perforation And this is very interesting So there will be a push out bone strength So we need to have a material with push out bone strength So it is essential that a perforation repair material should have sufficient Amount of push out bone strength With dental walls For the prevention of dislodgement from the repair site So this has that good push out bone strength To act as a resorption repairative material So by a compatibility it is very low cytotoxic And it has got very good tissue acceptability So it can be used for capping perforation repair Or as a retrograde filling So I mentioned in the beginning Same material can be used as a retrograde filling Then for resorption purpose or for regenerative purpose So when question was asked you can include all of these Now we have some newer materials So newer materials actually should come before this So the first one is ERRM That is Endosvequence Root Repair Material So it is a putty and paste based material It is available as ready to use pre-mixed bioceramic material Recommended for perforation repair, apical surgery, apical blood and pulp capping So this was asked once that is a newer material in Root filling group So first one was ERRM The next is PRF that is Platelet Ridge Fibrin So these biomaterials are native or synthetic polymers That perform as scaffolds for tissue regeneration And hold very important role in the field of dentistry Or drug delivery, cancer treatment, thrombotic diseases and cosmetic surgery So this PRF is a very newer material which can be used as to regenerate the lost dental tissues So various bioactive materials are available into this time like MTA, Biactive Glass and Bio Aggregate materials So in regenerative entomotic therapy an ideal otologous material for pulp dentine complex is our PRF that is a platelet ridge fibrin This has got regenerative potential unlike all these MTA and other materials So it was developed by Choclon in 2001 It has got growth factors like platelet derived growth factor and transformed growth factor beta So it sees for at least one week and up to 28 days So it keep on releasing till 28 days So its application include root coverage, bond regeneration, treatment of end up, revolution, sinus lift procedure, stabilizing the graft material in augmentation procedure, socket preservation, filling of cystic cavities and various medical fields So it represents a revolutionary step in platelet shell therapeutic concept So what is the advantage of platelet ridge fibrin over platelet ridge plasma They are known biochemical handling of blood simplified and cost effective Use of bovine thrombin and anticoagulants are not required A favorable healing due to slow polymerization, more efficient cell migration and proliferation It has got supportive effect on immune system and it helps in hemostasis So these are the advantages of PRF over PRP So how do we prepare this PRF? So it is very simple Collection of all venous blood around 5 ml in each of the two sterile tubes without anticoagulant And these tubes are placed in a centrifugal machine for 3000 rpm for 10 minutes After which it sets cells into following three layers That is the upper straw colored cellular plasma, then red color lower fraction containing RBCs Whereas the middle fraction containing the fibrin clot So this is our area fibrin clot PRF Now we have a newer material that is endosequence BCRRM So this RRM is nothing but root repair material It is available in two specifically formulated consistencies Syringeable paste or condensable protein and contains many of the same characteristics of BCRRRM It basically includes calcium silicate, calcium phosphate, monobasic, zirconium oxide, tantalum oxide, filler and thickening agent and its pH is greater than So it is more of an alkaline nature So it has got good favorable, good handling properties, increased strength and shortened Setting time makes this material highly resistant to wash out and ideal for all root repair and pulp camping procedure It is very highly biocompatible and osteogenic It creates bone formation The next one is iRoot BP Plus Bioceramic Party This is like a fully lab synthesized water-based bioceramic cement It is ready to use white hydraulic premixed formula It is biocompatible and did not induce critical cytotoxic effect So all you need to learn this at least the name of the newer material So that you get more content in writing if the question was asked The newer segment of root repair or newer materials in the root and filling section So at least write the title and one or two bullet points Next is a bio aggregate It appears to be modified or synthetic version of original MTA It has got ceramic nanoparticles and deionized water So this appear to be biocompatible compared with the blue MTA on human pulp cell, VDL cells and NG63 cells It contains calcium silicate, hydrate, aluminum hydrate, calcium hydroxide All these things hydroxyapatite, smithoxate, n-clamoxate, calcium sulphate and amorphous silicon oxide And we have the novel root and filling material NRC So the novel resin based root and filling material Termed as newer resin cement or NRC It's a powder and liquid system This liquid composed of this hydroxy, ethyl, methacrylate, benzoyl peroxide Toludine and toluene sulfonate And the powder is made up of calcium oxide, calcium silicate and triphenyl bismuth carbonate So this is a very newer one So that was all about the root repair material We covered many materials, the existing one MTA and the newer ones And all these can be used as a root and filling material Then for the repair or for resorption repair And as a regenerative material Some materials have got regenerative potential Like this biogregate This PRF, biodentine All this got this regenerative potential Whereas some are excellent in pickle plugging like MTA And commonly used our old ones that is eugenol based They have two different modifications that is super EBA and IRM And amalgam-gattapucha All those things with GAC and composite That it is also there So hope you understood this topic It will be definitely asked for a short essay or long essay Or MTA alone can be asked as a short note So it's a very important topic All these points would be sufficient to be true Good marks and description So I'll come up with a new topic in Enderontics Thank you