Endocem ZR (white)

Some issues may arise when using MTA for endodontic microsurgery and vital pulp therapy over time.

The first issue is that of compromised aesthetics. There are numerous products that are alleged to be tooth-colored which are designed for use on anterior teeth. Many of these products do not meet expectations aesthetically, as discoloration is seen on treated or adjacent teeth after clinical application.

Another issue is that of calcification. When vital pulp therapy is performed on anterior teeth using MTA, a partial pulpotomy is often performed to ensure adequate thickness of MTA and the final restoration. When doing so, calcification of the root canal or pulp chamber ensues, problematic for future treatment. 

Endocem Zr is the most aesthetic MTA with minimal tooth discoloration. It is the safest MTA that exhibits low-grade decalcification of pulp chambers and root canals even long after partial pulpotomy therapy. Great handling properties in partial pulpotomy therapy of anterior teeth such as fast setting time, flowability, and radiopacity allow for meticulous sealing of long, narrow canals of anterior teeth.

MINIMAL DISCOLORATION · MINIMAL CALCIFICATION
With Endocem Zr, tooth discoloration and calcification of pulp chamber and root canal have been minimized.

Apical view of tooth extracted 1 year after intentional transplantation (retro-filling with Endocem Zr) was performed for regeneration of alveolar bony tissue. No tooth discoloration is found.

Crown of a wisdom tooth that engages IAC was removed and partial pulpotomy was performed using Endocem Zr, extracted 8 months after treatment. No discoloration whatsoever is found at the sectioned surface of the extracted wisdom tooth. However, it should be noted that if bacterial growth ensues, the ENDOCEM Zr surface may become discolored because ENDOCEM Zr is porous in structure and has no cytotoxicity. Also, long term exposure to saliva or tissue fluid could cause degradation of the surface and thus cause the surface to darken.

To avoid discoloration, treatment should be done with bleeding controlled, and the surface of ENDOCEM Zr should be covered for protection by composite resin after setting.



This SEM view shows a thin layer of secondary dentin on the ENDOCEM Zr contact area, with healthy pulp tissue free from infiltration of inflammatory cells or calcification of pulp chamber or root canal.

For additional research see product information for Endocem MTA

Caution:

• Application of direct occlusal force should be avoided because ENDOCEM Zr exhibits less tensile strength than conventional MTA.

• ENDOCEM Zr should be used as a liner, not as a base, in vital pulp therapy.
• Composite resin with a sufficient thickness is absolutely necessary to avoid contamination with saliva, discoloration and compromise of sealing.
• Although lack of bleeding control does not affect treatment outcomes, it may cause discoloration.
• Bleeding may be controlled by filling 5.25% NaOcl in the cavity.
• ENDOCEM Zr should be applied immediately after bleeding is controlled and excess NaOcl is absorbed.
• Blood clots formed through this process are key to successful tissue regeneration.
• After ENDOCEM Zr application, sealing should be maximized according to clinician preference, such as condensing with the handle of a paper point.
• In partial pulpotomy, if excessive force is used to place ENDOCEM Zr in the pulp chamber or root canal, severe discomfort including percussion reaction could occur.
• If problems are found on post-operative radiographs the clinician may notify the patient and prescribe anti-inflammatory analgesicst.
• Blood supply plays an important role in a partial pulpotomy; if blood supply is insufficient the treatment should be completed by performing direct pulp capping.
• Once unsealed, ENDOCEM Zr must be used and discarded, as it may become denatured and result in failure.

Other Resources:

Endocem ZR, Instruction for Use

Case Studies:

Partial pulpotomy performed using ENDOCEM Zr and resin filling restoration on a fractured anterior tooth. Unlike conventional MTA cases, there is no dark color observed underneath the restoration.