[Materials in endodontic praxis]

Bengtsson, Ulf
[Dental Materials In Endodontic Praxis. Ed 1.]
LiTH-IKP-I-137. 1990.

An editorial note:
For readers who don't understand Swedish, this Summary is a substitute. However, there is a lot more to find. Useful links are the following:
Reference Matrix (In Swedish "Referensmatris")
Here you will find a chart over products, ingredients and literature references for the information given. Also, there are links to the text for products of which formulations are given.
[A lexical register over ingredients in root filling materials.] (In Swedish "Lexikalisk förteckning...")
Should be self explanatory.
[Cross references for synonyms.] Includes English and Latin names. (In Swedish "Korsreferenser")
In this section you find all the names of ingredients including synonyms with links to the register above.
[References.] (In Swedish "Referenslista")

On this page you find the links above in the margin, and in English. The Swedish names are in the margins of all other pages, so they are given to help navigating.
This is important information for consumers, because producers, authorities, and dentists will not give full information. In this context also the dentist is to be regarded as a consumer, because he or she will not know the full contents of the ingredients used. Some because traders and producers do not want to tell, some hidden as trade secrets. All of course for the patient's safety, a peculiar use of the precautionary principle. The article has been on the Internet before, but the link has been broken. It's a pleasure to make it available again. BW

1.1 Summary
The overwhelming majority of all root canal fillings in Sweden today are made with gutta-percha. A number of different gutta-percha brands contains 0,6-0,7% cadmium, probably due to cadmium-based color pigment. Cadmium-pigments are prohibited in Sweden since 1982. In a special regulation the Naturvårdsverket has made an exception for dental materials. In this kind of endodontic therapy based on gutta-percha, chloroform is used both as an ingredient in a so called sealer and as a solvent for the gutta-percha itself. No drugs sold in Sweden contains chloroform. In the USA the use of chloroform is prohibited in both drugs an cosmetics due to its cancerogenity.
Compared to the situation in the 1950'ies, 1960'ies and partly the 1970'ies a considerable improvement has taken place in the use of dental materials and intra-canal medication in endodontic therapy. Among the patients there are however those who have root canal-fillings performed with materials and methods common in those days. It is appropriate that a report dealing with ingredients in endodontic materials should take into account fillings that actualy are placed in the teeth of the patients today, even though the number of fillings from the beginning of the period are relatively few. The majority of the root canal filling materials studied are described in scientific litterature within the last ten years. Devitalizing-, sterilizing- and irrigation agents used temporarily in the beginning of the therapy before the permanent obturation of the root canal has also been studied.
Among the ingredients in preparations used as root canal filling-materials described in scientific litterature from the 1950'ies and onwards we have found: Asphalt, benzine, lead oxide, phenol, phenylmercuy, formaldehyde, cadmium, creosote and others. In devitalizing agents arsenic, phenol and cocain has been used.
A considerable number of ingredients in preparations used as root canal filling materials has also been used in the manufacturing of paints, lacquers and varnishes. Among these ingredients also used in the paint-industry we have found alum, arsenic trioxide, lead oxide, resin, champhor, Canada balsam, bismuth carbonate and others. Other ingredients has been used as pesticides and fungicides because of their strong biological activity: Arsenic trioxide, dichlorophene, 8-hydroxyquinoline and tricresol. Today, a number of the ingredients found are regarded as environmental hazards.
Several modern dental materials, among others glass-ionomer cements, contain substantial amounts of fluoride. Due to the instability of these materials an intensional and prolonged release of fluoride ions takes place in order to reduce the incidence of caries. Fluoride containing pastilles and rinsing agents are regulated in the drug act whereas the use of fluoride leaching dental materials are unregulated.
One root filling material, N2, has been used in a very large scale despite the fact that it has been illegalized and the use has been declared not to conform to acceptable treatment standards. A society, the Swedish Endodontic Society, SES, has been formed in order to promote the use of N2 in opposition to the regulations and regardless of the scientific evidence showing adverse effects. The Socialstyrelsen has for a long period of time, despite detailed information on the misuse of N2, omitted to take powerful action against the cement. Since 1958 when the N2-method was introduced in Sweden, 1.5 - 2 million root canals has been treated with N2.
Approximately 50 % of all root canal treatments results in over-filling. This means that the filling material is forced out of the root and into contact with the surrounding tissue. Convincing scientific evidence has shown that these overfillings are gradualy resorbed and spread systemically.
The problems with the bicompatibility of dental materials has been identified. Biological testing of dental materials has begun. The need for biological testing only applies to new materials however. Old, well established materials dealt with in this report will in practice not have to be tested.
At the opening of the EC's single market in 1992 there will be a new set of standards for dental materials. The work with these are under way at CEN. These standards will apply to both EC- and EFTA-countries which means that Sweden will be affected to a great extent. Sweden is not participating in this work and will not have any influence on the standards for biological testing of dental materials after 1992 unless big efforts are made within a very near future.
Neither central registration of adverse effects nor licensing of dental materials are conducted in Sweden at present. According to a regulation from the Socialstyrelsen information on both type of dental material and manufacturer has got to be entered in the patients case-book. Any adverse effect or suspected adverse effect has also got to be recorded.

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Latest update 2006-04-03

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