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Root-canal-filling materials are either placed directly onto vital periapical tissues or may leach through dentine. The tissue response to these materials therefore becomes important and may influence the outcome of endodontic treatment. This paper is a review of the biocompatibility of contemporary orthograde and retrograde root-canal-filling materials.
The root canal filling paste Vitapex (Neo Dental Chemical Products Co., Tokyo), made of calcium hydroxide and iodoform with the addition of silicone oil, was experimentally introduced into the mandibular canals of 29 dogs. Tissue reactions to the paste were examined by radiography, histopathology, and electron microscopy. These examinations revealed that the paste was phagocytosed by macrophages and, in general, was gradually resorbed over time. The paste was also found to cause heterotopic calcification and/or ossification within the area of original penetration.
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The root canal filling material "Vitapex" (Neo Dental Chemical Products Co., Tokyo), made of calcium hydroxide and iodoform with the addition of silicone oil, was experimentally injected into the mandibular canals of dogs, and its effect on the alveolar nerve tissue was examined by light and electron microscopy. No change was observed as long as the injected paste did not come into direct contact with the nerve, but tissue damage was found at sites of direct contact. After removal of degenerated nerve debris by macrophages and Schwann cells, the persisting external membranes or "Schwann tubes" appeared to provide a scaffolding for axonal regeneration and Schwann cell proliferation.
This report compares tissue irritation by a newly developed calcium-based root canal filling material with irritation by previously available materials and evaluates the toxicity of various components in the root canal filling material. Polyethylene tubes filled with root canal filling materials were implanted in rat subcutaneous tissue, enucleated after 2, 4, 8 and 12 weeks, and histopathologically evaluated for tissue reaction. The tissue inflammation was microscopically evaluated and divided into 4 grades. The new root canal filling material has good tissue affinity compared to prior material. Transmission electronic microscopy and X-ray analysis revealed: titanium in AH-26; barium and bismuth in Canals, Tubli-seal and the newly developed root canal filling cement A; and zinc in the root canal filling cement B. Tissue was variously inflamed and, occasionally, necrosis was induced in the cells. The newly developed root canal filling cement A, showed better tissue affinity and no or slightly morphology change.
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The canals of 20 human dental roots were instrumented using a a step- back technique. The smear layer was removed, and the canals were obturated with composite resin. Two different techniques of compaction were used: either vertical or lateral motions were used to condense composite resin inside the root canal that was then photopolymerized layer by layer using the argon laser (488 nm). The beam was delivered into the root canal by means of an optical fiber 320 micrometers in diameter. Longitudinal and cross-sections of the samples and resin replicas of the root canals were examined using a light and scanning electron microscope. Scanning electron microscopic examination revealed that laterally compacted resin fillings showed fewer voids than those obtained by vertical compaction. In both experimental groups, adhesion of the resin to the dentin walls, pulled-out resin tags, microfailure, and resin fracture, leaving a layer of resin associated with the wall surface were observed.
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The process of engulfment of overextended root canal filling materials was investigated in rat peritoneal macrophages in vitro. Root canal filling materials tested were Finapec APC, Sealapex, Canals-N, and Canals. The phagocytosis rate of macrophages for the Finapec APC was significantly (p < 0.05) higher than that for other three root canal filling materials. That for Canals was the lowest. About 95% of the cells exposed to Finapec APC were viable at 60 and 120 min. For Canals the percentage was 74% and 63% at 60 and 120 min, respectively. Ruffle formation in macrophages was observed by scanning electron microscopy after exposure to Finapec APC for 60 or 120 min. Many vacuoles were observed in macrophages exposed to Canals for 60 min. It was concluded that the phagocytic rate of macrophages for Canals that showed a strong cytotoxicity was lowest and that the rate for Finapec APC that showed a low cytotoxicity was the highest.
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