Restor Dent Endod.  2013 Aug;38(3):119-127.

Biocompatibility of root-end filling materials: recent update

• Saxena P
• Gupta SK
• Newaskar V

Abstract

The purpose of a root-end filling is to establish a seal between the root canal space and the periradicular tissues. As root-end filling materials come into contact with periradicular tissues, knowledge of the tissue response is crucial. Almost every available dental restorative material has been suggested as the root-end material of choice at a certain point in the past. This literature review on root-end filling materials will evaluate and comparatively analyse the biocompatibility and tissue response to these products, with primary focus on newly introduced materials.

Keyword

Biocompatibility; Comparative evaluation; Root-end filling; Toxicity

MeSH Terms

Dental Pulp Cavity

Reference

1. Gatewood RS. Endodontic materials. Dent Clin North Am. 2007; 51:695–712.

2. Andreasen JO. Cementum repair after apicoectomy in humans. Acta Odontol Scand. 1973; 31:211–221.

3. Regan JD, Gutmann JL, Witherspoon DE. Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues. Int Endod J. 2002; 35:840–847.

4. Dahl JE. Toxicity of endodontic filling materials. Endod Topics. 2005; 12:39–43.

5. Glickman GN, Hartwell GR. Chapter 33. Endodontic surgery. In : Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle's Endodontics. 6th ed. Hamilton: BC Decker Inc;2008. p. 1261–1294.

6. Chong BS, Pitt Ford TR. Root-end filling materials: rationale and tissue response. Endod Topics. 2005; 11:114–130.

7. Gutmann JL, Harrison JW. Posterior endodontic surgery: anatomical considerations and clinical techniques. Int Endod J. 1985; 18:8–34.

8. Friedman S. Retrograde approaches in endodontic therapy. Endod Dent Traumatol. 1991; 7:97–107.

9. In : Pitt Ford TR, editor. Harty's Endodontics in Clinical Practice. 5th ed. Edinburgh: Wright;2004. Chapter 9, Surgical endodontics. p. 143–181.

10. In : Anusavice KJ, editor. Phillip's Science of Dental Materials. 11th ed. St Louis: Saunders;2003. Chapter 8, Biocompatibility of dental materials. p. 171–202.

11. Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP. Effect of IRM root end fillings on healing after replantation. J Endod. 1994; 20:381–385.

12. Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP. Effect of various zinc oxide materials as root-end fillings on healing after replantation. Int Endod J. 1995; 28:273–278.

13. Chong BS, Ford TR, Kariyawasam SP. Tissue response to potential root-end filling materials in infected root canals. Int Endod J. 1997; 30:102–114.

14. Chong BS, Pitt Ford TR, Kariyawasam SP. Short-term tissue response to potential root-end filling materials in infected root canals. Int Endod J. 1997; 30:240–249.

15. Kimura JT. A comparative analysis of zinc and non-zinc alloys used in retrograde endodontic surgery. Part 1: apical seal and tissue reaction. J Endod. 1982; 8:359–363.

16. Kimura JT. A comparative analysis of zinc and nonzinc alloys used in retrograde endodontic surgery. Part 2: optical emission spectrographic analysis for zinc precipitation. J Endod. 1982; 8:407–409.

17. Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP. Effect of super-EBA as a root end filling on healing after replantation. J Endod. 1995; 21:13–15.

18. Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR, Miller DA, Kariyawasam SP. Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys. J Endod. 1997; 23:225–228.

19. Baek SH, Plenk H Jr, Kim S. Periapical tissue responses and cementum regeneration with amalgam, SuperEBA, and MTA as root-end filling materials. J Endod. 2005; 31:444–449.

20. Kaplan SD, Tanzilli JP, Raphael D, Moodnik RM. A comparison of the marginal leakage of retrograde techniques. Oral Surg Oral Med Oral Pathol. 1982; 54:583–585.

21. Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP. Effect of various sealers with gutta-percha as root-end fillings on healing after replantation. Endod Dent Traumatol. 1996; 12:33–37.

22. Wälivaara DA, Abrahamsson P, Isaksson S, Salata LA, Sennerby L, Dahlin C. Periapical tissue response after use of intermediate restorative material, gutta-percha, reinforced zinc oxide cement, and mineral trioxide aggregate as retrograde root-end filling materials: a histologic study in dogs. J Oral Maxillofac Surg. 2012; 70:2041–2047.

23. Phillips RW, Love DR. The effect of certain additive agents on the physical properties of zinc oxide-eugenol mixtures. J Dent Res. 1961; 40:294–303.

24. Weine FS. Endodontic Therapy. 4th ed. St Louis: Mosby;1982. p. 498–502.

25. Torabinejad M, Walton RE. Principles and Practice of Endodontics. 3rd ed. Philadelphia: Saunders;2002. p. 275–278.

26. Hendra LP. EBA cement. A practical system for all cementation. J Br Endod Soc. 1970; 4:28–32.

27. Oynick J, Oynick T. A study of a new material for retrograde fillings. J Endod. 1978; 4:203–206.

28. Jeng JH, Hahn LJ, Lu FJ, Wang YJ, Kuo MY. Eugenol triggers different pathobiological effects on human oral mucosal fibroblasts. J Dent Res. 1994; 73:1050–1055.

29. Meryon SD, Jakeman KJ. The effects in vitro of zinc released from dental restorative materials. Int Endod J. 1985; 18:191–198.

30. Haglund R, He J, Jarvis J, Safavi KE, Spångberg LS, Zhu Q. Effects of root-end filling materials on fibroblasts and macrophages in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95:739–745.

31. Al-Sabek F, Shostad S, Kirkwood KL. Preferential attachment of human gingival fibroblasts to the resin ionomer Geristore. J Endod. 2005; 31:205–208.

32. Al-Hiyasat AS, Al-Sa'Eed OR, Darmani H. Quality of cellular attachment to various root-end filling materials. J Appl Oral Sci. 2012; 20:82–88.

33. Barkhordar RA, Pelzner RB, Stark MM. Use of glass ionomers as retrofilling materials. Oral Surg Oral Med Oral Pathol. 1989; 67:734–739.

34. Pissiotis E, Sapounas G, Spångberg LS. Silver glass ionomer cement as a retrograde filling material: a study in vitro. J Endod. 1991; 17:225–229.

35. Pissiotis E, Spângberg L. Reaction of bony tissue to implanted silver glass ionomer and a reinforced zinc oxide-eugenol cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:623–629.

36. Brook IM, Hatton PV. Glass-ionomers: bioactive implant materials. Biomaterials. 1998; 19:565–571.

37. Callis PD, Santini A. Tissue response to retrograde root filling in the ferret canine: a comparison of a glass ionomer cement and gutta-percha with sealer. Oral Surg Oral Med Oral Pathol. 1987; 64:475–479.

38. Geurtsen W. Biocompatibility of resin-modified filling materials. Crit Rev Oral Biol Med. 2000; 11:333–355.

39. Andreasen JO, Rud J, Munksgaard EC. Retrograde root obturations using resin and a dentin bonding agent: a preliminary histologic study of tissue reactions in monkeys. Tandlaegebladet. 1989; 93:195–197.

40. Trope M, Lost C, Schmitz HJ, Friedman S. Healing of apical periodontitis in dogs after apicoectomy and retrofilling with various filling materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81:221–228.

41. Camp MA, Jeansonne BG, Lallier T. Adhesion of human fibroblasts to root-end filling materials. J Endod. 2003; 29:602–607.

42. Gupta SK, Saxena P, Pant VA, Pant AB. Adhesion and biologic behavior of human periodontal fibroblast cells to resin ionomer Geristore: a comparative analysis. Dent Traumatol. 2012; 11. 06. [Epub ahead of print]. DOI: 10.1111/edt.12016.

43. Williams SS, Gutmann JL. Periradicular healing in response to Diaket root-end filling material with and without tricalcium phosphate. Int Endod J. 1996; 29:84–92.

44. Kettering JD, Torabinejad M. Cytotoxicity of root canal sealers: a study using HeLa cells and fibroblasts. Int Endod J. 1984; 17:60–66.

45. Spångberg L. Biological effects of root canal filling materials. 7. Reaction of bony tissue to implanted root canal filling material in guineapigs. Odontol Tidskr. 1969; 77:133–159.

46. Olsson B, Wennberg A. Early tissue reaction to endodontic filling materials. Endod Dent Traumatol. 1985; 1:138–141.

47. Nencka D, Walia H, Austin BP. Histological evaluation of the biocompatibility of Diaket. J Dent Res. 1995; 74:Supplement 1. 101.

48. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006; 32:601–623.

49. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010; 36:400–413.

50. Thomson TS, Berry JE, Somerman MJ, Kirkwood KL. Cementoblasts maintain expression of osteocalcin in the presence of mineral trioxide aggregate. J Endod. 2003; 29:407–412.

51. Pistorius A, Willershausen B, Briseño Marroquin B. Effect of apical root-end filling materials on gingival fibroblasts. Int Endod J. 2003; 36:610–615.

52. Pelliccioni GA, Ciapetti G, Cenni E, Granchi D, Nanni M, Pagani S, Giunti A. Evaluation of osteoblast-like cell response to Proroot MTA (mineral trioxide aggregate) cement. J Mater Sci Mater Med. 2004; 15:167–173.

53. Huang TH, Yang CC, Ding SJ, Yan M, Chou MY, Kao CT. Biocompatibility of human osteosarcoma cells to root end filling materials. J Biomed Mater Res B Appl Biomater. 2005; 72:140–145.

54. Al-Rabeah E, Perinpanayagam H, MacFarland D. Human alveolar bone cells interact with ProRoot and tooth-colored MTA. J Endod. 2006; 32:872–875.

55. Souza NJ, Justo GZ, Oliveira CR, Haun M, Bincoletto C. Cytotoxicity of materials used in perforation repair tested using the V79 fibroblast cell line and the granulocyte-macrophage progenitor cells. Int Endod J. 2006; 39:40–47.

56. Yoshimine Y, Ono M, Akamine A. In vitro comparison of the biocompatibility of mineral trioxide aggregate, 4META/MMA-TBB resin, and intermediate restorative material as root-end filling materials. J Endod. 2007; 33:1066–1069.

57. Vajrabhaya LO, Korsuwannawong S, Jantarat J, Korre S. Biocompatibility of furcal perforation repair material using cell culture technique: Ketac Molar versus Pro-Root MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:e48–e50.

58. Gorduysus M, Avcu N, Gorduysus O, Pekel A, Baran Y, Avcu F, Ural AU. Cytotoxic effects of four different endodontic materials in human periodontal ligament fibroblasts. J Endod. 2007; 33:1450–1454.

59. Asrari M, Lobner D. In vitro neurotoxic evaluation of root-end filling materials. J Endod. 2003; 29:743–746.

60. Gomes-Filho JE, de Faria MD, Bernabé PF, Nery MJ, Otoboni-Filho JA, Dezan-Júnior E, de Moraes Costa MM, Cannon M. Mineral trioxide aggregate but not light-cure mineral trioxide aggregate stimulated mineralization. J Endod. 2008; 34:62–65.

61. Gomes-Filho JE, de Moraes Costa MM, Cintra LT, Duarte PC, Takamiya AS, Lodi CS, Bernabé PF. Evaluation of rat alveolar bone response to Angelus MTA or experimental light-cured mineral trioxide aggregate using fluorochromes. J Endod. 2011; 37:250–254.

62. Gomes-Filho JE, de Moraes Costa MT, Cintra LT, Lodi CS, Duarte PC, Okamoto R, Bernabé PF, Nery MJ, Cannon M. Evaluation of alveolar socket response to Angelus MTA and experimental light-cure MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:e93–e97.

63. Gomes-Filho JE, Rodrigues G, Watanabe S, Estrada Bernabé PF, Lodi CS, Gomes AC, Faria MD, Domingos Dos Santos A, Silos Moraes JC. Evaluation of the tissue reaction to fast endodontic cement (CER) and Angelus MTA. J Endod. 2009; 35:1377–1380.

64. Brasseler USA Co.Endosequence root repair material paste, Information. updated 2010 Dec. Available from: http://www.brasselerusa.com/display.cfm?pid=newproducts.

65. Alanezi AZ, Jiang J, Safavi KE, Spangberg LS, Zhu Q. Cytotoxicity evaluation of endosequence root repair material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109:e122–e125.

66. Ma J, Shen Y, Stojicic S, Haapasalo M. Biocompatibility of two novel root repair materials. J Endod. 2011; 37:793–798.

67. Damas BA, Wheater MA, Bringas JS, Hoen MM. Cytotoxicity comparison of mineral trioxide aggregates and EndoSequence bioceramic root repair materials. J Endod. 2011; 37:372–375.

68. Chung CR, Kim E, Shin SJ. Biocompatibility of bioaggregate cement on human pulp and periodontal ligament (PDL) derived cells. J Korean Acad Conserv Dent. 2010; 35:473–478.

69. Lee JH, Shon WJ, Lee W, Baek SH. The effect of several root-end filling materials on MG63 osteoblast-like cells. J Korean Acad Conserv Dent. 2010; 35:222–228.

70. Innovative BioCeramix, Inc Co.Information. updated 2012 Jan. Available from: http://www.ibioceramix.com/Publications.html.

71. De-Deus G, Canabarro A, Alves GG, Marins JR, Linhares AB, Granjeiro JM. Cytocompatibility of the ready-to-use bioceramic putty repair cement iRoot BP Plus with primary human osteoblasts. Int Endod J. 2012; 45:508–513.

72. Kim M, Ko H, Yang W, Lee Y, Kim S, Mante FK. A new resin-bonded retrograde filling material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:e111–e116.

73. Yang WK, Ko HJ, Kim MR. Evaluation of the rat tissue reaction to experimental new resin cement and mineral trioxide aggregate cement. Restor Dent Endod. 2012; 37:194–200.

74. Wei W, Qi YP, Nikonov SY, Niu LN, Messer RL, Mao J, Primus CM, Pashley DH, Tay FR. Effects of an experimental calcium aluminosilicate cement on the viability of murine odontoblast-like cells. J Endod. 2012; 38:936–942.

75. Aguilar FG, Roberti Garcia LF, Panzeri Pires-de-Souza FC. Biocompatibility of new calcium aluminate cement (EndoBinder). J Endod. 2012; 38:367–371.

76. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999; 25:197–205.

77. Ørstavik D, Nordahl I, Tibballs JE. Dimensional change following setting of root canal sealer materials. Dent Mater. 2001; 17:512–519.

78. Porter ML, Bertó A, Primus CM, Watanabe I. Physical and chemical properties of new-generation endodontic materials. J Endod. 2010; 36:524–528.

79. Bird DC, Komabayashi T, Guo L, Opperman LA, Spears R. In Vitro evaluation of dentinal tubule penetration and biomineralization ability of a new root-end filling material. J Endod. 2012; 38:1093–1096.

80. Washington JT, Schneiderman E, Spears R, Fernandez CR, He J, Opperman LA. Biocompatibility and osteogenic potential of new generation endodontic materials established by using primary osteoblasts. J Endod. 2011; 37:1166–1170.

81. Laurent P, Camps J, De Méo M, Déjou J, About I. Induction of specific cell responses to a Ca₃SiO₅-based posterior restorative material. Dent Mater. 2008; 24:1486–1494.

82. Goldberg M, Pradelle-Plasse N, Tran X, Colon P, Laurent P, Aubut V, About I, Boukpessi T, Septier D. Emerging trends in (bio)material researches. In : Goldberg M, editor. Biocompatibility or cytotoxic effects of dental composites. Oxford: Coxmoor Publishing;2009. p. 181–203.

83. Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J. 2011; 44:1081–1087.

84. Zhou HM, Shen Y, Wang ZJ, Li L, Zheng YF, Häkkinen L, Haapasalo M. In Vitro cytotoxicity evaluation of a novel root repair material. J Endod. 2013; 39:478–483.

85. Krishnan PS, Joshi M, Bhargava P, Valiyaveettil S, He C. Effect of heterocyclic based organoclays on the properties of polyimide-clay nanocomposites. J Nanosci Nanotechnol. 2005; 5:1148–1157.

86. Modareszadeh MR, Chogle SA, Mickel AK, Jin G, Kowsar H, Salamat N, Shaikh S, Qutbudin S. Cytotoxicity of set polymer nanocomposite resin root-end filling materials. Int Endod J. 2011; 44:154–161.

87. Lee SJ, Chung J, Na HS, Park EJ, Jeon HJ, Kim HC. Characteristics of novel root-end filling material using epoxy resin and Portland cement. Clin Oral Investig. 2013; 17:1009–1015.

88. Ndong F, Sadhasivam S, Lin FH, Savitha S, Wen-Hsi W, Lin CP. The development of iron-free partially stabilized cement for use as dental root-end filling material. Int Endod J. 2012; 45:557–564.

89. Coon D, Gulati A, Cowan C, He J. The role of cyclooxygenase-2 (COX-2) in inflammatory bone resorption. J Endod. 2007; 33:432–436.

90. Hammad HM, Hamadah MA, Al-Omari WM. Histological evaluation of rat tissue response to GMTA, Retroplast, and Geristore retrograde filling materials. Aust Endod J. 2011; 37:18–25.

91. Song M, Kim E. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxybenzoic acid as root-end filling materials in endodontic microsurgery. J Endod. 2012; 38:875–879.

92. Chong BS, Pitt Ford TR, Hudson MB. A prospective clinical study of mineral trioxide aggregate and IRM when used as root-end filling materials in endodontic surgery. Int Endod J. 2003; 36:520–526.

93. Lindeboom JA, Frenken JW, Kroon FH, van den Akker HP. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:495–500.

94. Wälivaara DÅ, Abrahamsson P, Fogelin M, Isaksson S. Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112:258–263.

95. Saunders WP. A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling. J Endod. 2008; 34:660–665.

96. Christiansen R, Kirkevang LL, Hørsted-Bindslev P, Wenzel A. Randomized clinical trial of root-end resection followed by root-end filling with mineral trioxide aggregate or smoothing of the orthograde gutta-percha root filling - 1-year follow-up. Int Endod J. 2009; 42:105–114.

97. Evidence-based review of clinical studies on the root apex. J Endod. 2009; 35:1158–1159.

98. Wälivaara DA, Abrahamsson P, Sämfors KA, Isaksson S. Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:784–789.