Zinc oxide-eugenol cements.

Many endodontic sealers are simply zinc oxide-eugenol cements that have been modified for endodontic use. The mixing vehicle for these materials is mostly eugenol. The powder contains zinc oxide that is finely sifted to enhance the flow of the cement. Setting time is adjusted to allow for adequate working time. Zinc oxide is a valuable component in the sealer. It is effective as an antimicrobial agent and has been shown to provide cytoprotection to tissue cells. The setting of zinc oxide-eugenol cements is a chemical process combined with physical embedding of zinc oxide in a matrix if zinc eugenolate partical size of zinc oxide, pH, and the presence of water regulate the setting and other additives that might be included in special formulas. The formation of eugenolate constitutes the hardening of the cement. Free eugenol always remains in the mass and acts as an irritant. Zinc oxide-eugenol cements lose some volume with time because if dissolution in tissues with the release of eugenol and zinc oxide.

A pulpectomy involves complete pulp tissue removal from the crown and root and is indicated when no vital tissue remains. It is also indicated when root maturation is complete and the permanent restoration requires a post buildup. In the absence of inflammatory root resorption, treatment is to obturate the canal with gutta-percha. One of the greatest challenges facing the clinician is the treatment of a nonvital immature permanent tooth with an open apex. In this case, an apexification procedure is indicated where calcium hydroxide stimulates the formation of a cementiod barrier against which gutta-percha can subsequently be condensed. Even though a good apical seal can be achieved in this manner, no dentinal wall deposition will occur in the root, and it will remain thin and fragile. These teeth are at risk for cervical crown or root fracture.

Indications - evidence of pulpal necrosis - hyperaemic pulp. The most common presentation of a hyperaemic pulp is persistent bleeding during a pulpotomy procedure. In this case, the radicular pulp should be removed and a pulpectomy performed instead. - evidence of furcation or periapical involvement on radiographs. - spontaneous pain (unstimulated pain) - buccal or extra oral swelling and increased mobility.

Contraindications for primary root canal fillings - a nonrestorable tooth - radiographically visible, internal resorption in the roots - teeth with mechanical or carious perforations of the floor of the pulp chamber -excessive pathologic root resorption involving more than one third of the root - the presence of a dentigerous or follicular cyst Internal resorption usually begins just inside the root canals near the furcation area. Because of the thinness of the roots of the primary teeth, once internal resorption has become visible radiographically, there is invariably a perforation of the root by the resorption. The short furcal surface area of the primary teeth leads to rapid communication between the inflammatory process and the oral cavity through the periodontal attachment. The end results is loss of the periodontal attachment of the tooth and further resorption and loss of the tooth.