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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 11  »  Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues
Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues
Discussion - References.

The two materials chosen for this evaluation have been shown to support varying degrees of regeneration under different experimental conditions (Torabinejad et al. 1995a,b,c, Snyder Williams & Gutmann1996a, Moretton et al. 2000). Diaket is a polyvinyl resin that was initially formulated as a root-canal sealer, whilst used as a root-canal sealer and empirically as a root-end filling material for over two decades, Tetsch (1986) first documented the use of Diaket as a root-end filling material, suggesting that it be mixed to a very thick consistency.
As a root-canal sealer, the material was mixed in a ratio of 1:1, powder to liquid. Walia et al. (1995) showed that Diaket used in a ratio of two to three parts powder to one part liquid produced a material that provided better apical seal than either IRM or Super-EBA in both1and 3-mm deep root-end preparations. The tissue response to Diaket mixed in this manner was evaluated by Nencka et al. (1995).They found the material to be biocompatible with bone. This same favourable response was noted by SnyderWilliams & Gutmann (1996a,b), Douthitt (1996) and Witherspoon & Gutmann (2000) when Diaket was used as a root-end filling material in a dog model. An ‘osteoid’ type material was consistently formed adjacent to the Diaket root-end filling (Fig. 4). This material has not yet been fully characterized using immuno-histochemical techniques or specific matrix antigens and these evaluative tests remain to be performed.
Based on previous animal studies using the dog model, it would appear that 60 days is an appropriate time to wait between completion of experimental procedure and sacrifice. Previous dog studies have evaluated healing at intervals shorter than 60 days (Craig & Harrison 1993, Torabinejad et al. 1995a,b,c, Douthitt et al. 2001), equal to 60 days (Regan et al. 1999, SnyderWilliams & Gutmann 1996b) and more than 60 days (Torabinejad et al.1995a,b,c,Trope et al.1996, Ne 2001).
MTA was developed ‘to seal communications between the tooth and the external surface’ (Lee et al. 1993). The main constituents of this material are tricalcium silicate (CaSiO4), bismuth oxide (Bi2O3), dicalcium silicate (2CaOSiO2), calcium sulphate (CaSO4), tricalcium aluminate (3CaOAl2O3), tetra calcium aluminoferrite (4CaOAl2O3FeO3) and an amorphous structure consisting of 33% calcium, 49% phosphate, 2% carbon, 3% chloride and 6% silica (Torabinejad et al.1995a,b,c). Torabinejad et al. (1993;1994a,b) further recommended the use of MTA as a root-end filling material based on its sealing properties when compared to amalgam, IRM and Super-EBA. In a series of in vitro and in vivo experiments, investigating the physical properties and biocompability of MTA, the same group reported that MTA compared favourably with both Super-EBA and IRM (Torabinejad et al.1994a,b; 1995a,b,c). Further studies have confirmed the biocompability of the MTA in cultures of osteoblasts (Koh et al. 1998, Mitchell et al. 1999, Zhu et al. 2000). In response to the material, cell growth was favourable and the expression of IL-6 and IL-8 suggests that it may promote healing through the stimulation of bone metabolism. The presence of IL-8 has been shown to stimulate angiogenesis, which is necessary for connective tissue healing (Hu et al.1993).
Takata et al. (1998) have shown that transforming growth factor-b1 (TGF-b1) influences the development, remodelling and regeneration of cells. MacNeil et al. (1995) noted that the phosphorylated glycoproteinosteopontin is expressed and localized to the root surface during cementogenesis. Ne (2001) demonstrated marked immunoreactivity for both TGF-b1 and osteopontin in response to the presence of MTA when used as a root end filling in a dog model. Whilst these studies may suggest that MTA is osteoinductive, Moretton et al. (2000) found that subcutaneous and intraosseous implants of EBA and MTA were not osteoinductive but rather osteoconductive.
Clinically, both materials are markedly different. Whilst the MTA material is easily mixed, its handling characteristics are not ideal. It can be difficult to place and compact in many root-end preparations. Diaket, on the other hand is very easy to place and compact as a root-end filling in virtually all prepared root ends. It sets hard in a short time, after which it can be polished with a fine diamond rotary instrument to produce a smooth finish. It is also more radiopaque than MTA, providing a clear radiographic image of the final restoration.
Ideally, the healing responses both in the presence or absence of superimposed infection and inflammation should be evaluated. However, in practical terms, this is not always possible owing to financial and temporal constraints. In addition, surgery is occasionally performed in the absence of an active infection (e.g. multirooted teeth, in teeth with root fractures, perforations, fractured instruments).
The evidence collected during this histological study would suggest that formation of a complete cemental coverage over both the root end and the root-end filling material was possible, though not predictable. However, this indicates that it is feasible to promote ‘a double seal’ following root-end surgery, incorporating both a physical and biological covering or ‘seal’of the resected root end.


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