In vitro study of the toxicity of a composite resin, silver amalgam, and Cavit

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

OBJECTIVE

To evaluate the tissue responses to implants of Ketac Silver and Super EBA cement in the guinea pig mandible.

STUDY DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

Root end filling materials: a review

When non-surgical attempts prove unsuccessful or are contraindicated, surgical endodontic therapy is needed to save the tooth. The procedure usually consists of exposure of the involved area, root end resection, root end preparation and insertion of a root end filling material. Numerous materials have been suggested as root end filling materials. This article is a review of the literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity, and usage test in experimental animals and humans.

Cytotoxicity of four root end filling materials

Leakage and scanning electron microscopic studies have shown that a mineral trioxide aggregate (MTA) used as root end filling material permits significantly less leakage and has better adaptation than other commonly used root end filling materials. Because these materials are in contact with the periradicular tissues, their cytotoxicity should be evaluated before in vivo tests. Using the agar overlay and radiochromium methods, the cytotoxicity of amalgam, Super EBA, IRM, and the MTA was evaluated. Statistical analysis of the data from the agar overlay technique shows that freshly mixed and set amalgam were significantly less toxic than the rest of tested materials (p< 0.00005). Fresh and set MTA ranked second when tested for cytotoxicity with this technique. Similar statistical tests revealed a significant statistical difference between the toxicity of freshly mixed and set materials after 24 h of incubation with radiochromium-labeled mouse L929 cells. The degree of cytotoxicity of fresh and set materials was MTA least toxic followed by amalgam, Super EBA, and IRM. Based on the results of the cell culture methods used in this study it appears that MTA is a potential root end filling material and warrants further in vivo evaluations.

Quantitative radioactive analysis of microleakage of four different retrograde fillings

Sealing properties of four different retrograde filling materials were investigated in vitro. Radioactive isotopes were applied in the root canal, and leakage into an extraradicular fluid was measured at regular intervals. The method permitted repeated observation of the specimens over prolonged periods of time. Forty single-rooted human teeth were biomechanically instrumented and obturated using calcium-hydroxide paste. Following obturation, an apicectomy was performed and retrograde cavities were filled with four different materials: group 1, non gamma 2 amalgam (Amalcap); group 2, glass ionomer cement (Ketac Silver); group 3, calcium-hydroxide-based root canal sealer (Sealapex); group 4, composite resin (Palfique Light-S). After removal of the calcium hydroxide, the teeth were immersed in a fluid. An isotope solution was then placed in the root canals. Samples were taken from the fluid at 0, 3, 7, 28, 56, 105, 210, 285 and 376 days to determine the radioactivity. It was found that Sealapex and Palfique Light-S showed significantly less leakage than amalgam and glass ionomer cement, which had the highest apical leakage.

Dental amalgam and mercury

This paper looks at the issues of the current amalgam controversy: the daily dose of mercury from amalgam, hypersensitivity to mercury, claims of adverse effects from amalgam mercury and alleged overnight "cures." In addition, the toxicity and allergenicity of the proposed alternative materials are examined with the same kind of scrutiny applied by the anti-amalgam group to dental amalgam.

Retrograde approaches in endodontic therapy

The routine use of retrograde fillings during apical surgery, as well as the material of choice for that purpose, have been debated. A retrograde filling is placed so as to seal an infected root canal causing periapical pathosis. Therefore, retrograde root canal fillings should be performed routinely during apical surgery regardless of the apparent technical quality of the root canal obturation, unless orthograde endodontic treatment is performed in conjunction with surgery. When orthograde treatment is not performed, retrograde root canal filling enhances the prognosis of apical surgery. An array of potential retrograde filling materials have been extensively investigated in vitro and in vivo. Once that the biocompatibility of the materials is confirmed a clinical comparison, rather than in vitro sealability studies, is the most valid evaluation method. Some of the difficulties encountered in long term clinical studies in patients may be avoided in animal studies. The review of the relevant literature of the past decade suggests that amalgam used in conjunction with cavity varnish is the retrograde filling material of choice. It must be stressed, however, that retrograde filling is not comparable to debridement and obturation of the entire root canal. Therefore, when the only way to approach the root canal is from the apical direction, rather than placing an apical retrograde filling, a retrograde endodontic treatment of the entire canal should be preferred, if it is feasible.

An in vitro method for longitudinal evaluation of toxicity of endodontic sealers

An in vitro method for longitudinal evaluation of root canal sealers was developed and applied. A newly introduced cell culture chamber was used to evaluate the cytotoxic effects of test samples immediately after mixing and for an extended period of time thereafter. A ranking of the test materials, based on their cytotoxicity, was allowed by the method.