<p>List of Contributors xi</p> <p><b>1 Introduction: Materials Chemistry as a Means to an End(o) – The Invisible Foundation 1<br /></b><i>Brian W. Darvell</i></p> <p>1.1 Introduction 1</p> <p>1.2 The Substrate 2</p> <p>1.3 Nomenclatural Hype: ‘Bioactivity’, ‘Bioceramics’ 3</p> <p>1.4 Chemical Interactions and Irrigation 6</p> <p>1.5 Terminology 9</p> <p>1.6 Classification of HSCs 11</p> <p>1.7 Conclusion 12</p> <p>References 13</p> <p><b>2 Pulp Capping Materials for the Maintenance of Pulp Vitality 15<br /></b><i>Phillip L. Tomson and Henry F. Duncan</i></p> <p>2.1 Introduction 16</p> <p>2.2 Maintaining Pulp Vitality 16</p> <p>2.2.1 Why Maintain the Pulp? 16</p> <p>2.2.2 Pulpal Irritants 16</p> <p>2.2.3 Pulpal Healing After Exposure 17</p> <p>2.2.4 Classifications of Pulpitis and Assessing the Inflammatory State of the Pulp 18</p> <p>2.2.5 Is Pulpal Exposure a Negative Prognostic Factor? 19</p> <p>2.2.6 Soft Tissue Factors Related to the Tooth 19</p> <p>2.3 Clinical Procedures for Maintaining Pulp Vitality 21</p> <p>2.3.1 Managing the Unexposed Pulp 21</p> <p>2.3.2 Tooth Preparation to Avoid Exposure 21</p> <p>2.3.3 Managing the Exposed Pulp 21</p> <p>2.3.3.1 Direct Pulp Capping 22</p> <p>2.3.3.2 Partial Pulpotomy 22</p> <p>2.3.3.3 Full Pulpotomy 22</p> <p>2.3.3.4 Pulpectomy 23</p> <p>2.3.4 Immature Roots 24</p> <p>2.4 Materials Used in Vital Pulp Treatment 25</p> <p>2.4.1 The Role of the Material 25</p> <p>2.4.2 Calcium Hydroxide 25</p> <p>2.4.3 Resin-Based Adhesives 27</p> <p>2.4.4 Hydraulic Calcium Silicate Cements 27</p> <p>2.4.5 Resin-Based Hydraulic Calcium Silicate Cements 29</p> <p>2.4.6 Glass Ionomer Cements 30</p> <p>2.4.7 Experimental Agents Used in Vital Pulp Treatment 31</p> <p>2.4.8 Tooth Restoration After VPT 32</p> <p>2.5 Clinical Outcome and Practicalities 32</p> <p>2.5.1 Vital Pulp Treatment Outcome 32</p> <p>2.5.2 Discolouration 32</p> <p>2.5.3 Setting Time and Handling 33</p> <p>2.6 Conclusion 33</p> <p>References 34</p> <p><b>3 Treatment of Immature Teeth with Pulp Necrosis 47<br /></b><i>Paul Cooper, Henry F. Duncan, Matthias Widbiller, and Kerstin M. Galler</i></p> <p>3.1 Introduction 48</p> <p>3.2 Apexification and Root-End Closure 49</p> <p>3.3 Revitalization 50</p> <p>3.3.1 Indications 50</p> <p>3.3.2 Procedure 51</p> <p>3.3.3 Outcome 51</p> <p>3.3.4 Limitations 52</p> <p>3.4 Material Requirements 52</p> <p>3.4.1 Materials and Applications 52</p> <p>3.4.2 Biological Requirements 54</p> <p>3.4.2.1 Bioactivity 54</p> <p>3.4.2.2 Reaction with Tissue Fluids 54</p> <p>3.4.2.3 Release of Dentine Matrix Proteins 55</p> <p>3.4.2.4 Blood Clot 55</p> <p>3.4.3 Mechanical Requirements 55</p> <p>3.4.3.1 Impact on Microhardness 55</p> <p>3.4.3.2 Discolouration 56</p> <p>3.5 Healing Process and Cellular Responses 57</p> <p>3.5.1 Biological Aspects 57</p> <p>3.5.2 Mineralization 60</p> <p>3.6 Future Directions: Tissue Engineering Approaches 62</p> <p>3.6.1 Principles of Tissue Engineering 62</p> <p>3.6.2 Dentine Matrix Proteins and Epigenetic Influences 63</p> <p>3.6.2.1 Dentine Matrix Components 63</p> <p>3.6.2.2 Growth Factors and Molecular Modulators 63</p> <p>3.6.2.3 Epigenetic Influences 64</p> <p>3.6.3 Cell-Based and Cell-Free Dental Pulp Tissue Engineering 65</p> <p>3.6.4 Clinical Approaches and Future Perspectives 66</p> <p>3.7 Conclusion 66</p> <p>References 66</p> <p><b>4 Endodontic Instruments and Canal Preparation Techniques 81<br /></b><i>Laurence Jordan, Francois Bronnec, and Pierre Machtou</i></p> <p>4.1 Classification and Components of Endodontic Instruments 82</p> <p>4.1.1 Brief History 82</p> <p>4.1.2 Alloys 84</p> <p>4.1.2.1 Carbon Steel versus Stainless Steel 84</p> <p>4.1.2.2 Nickel–Titanium 84</p> <p>4.1.3 Manufacture and Standardization 85</p> <p>4.1.3.1 Standardization of Stainless-Steel Instruments 85</p> <p>4.1.3.2 Design of Endodontic Instruments: Terms and Definitions 86</p> <p>4.1.3.3 Physical Properties of Endodontic Instruments: Terms and Definitions 90</p> <p>4.1.4 Cleaning and Shaping Instruments 90</p> <p>4.1.4.1 Group 1: Instruments for Hand Use (K-Files, H-Files, Barbed Broaches, Rasps) 90</p> <p>4.1.4.2 Group 2: Engine-Driven Latch-Type Instruments 94</p> <p>4.1.4.3 Group 3: Engine-Driven NiTi Rotary Instruments 94</p> <p>4.1.4.4 Group 4: Engine-Driven Instruments that Adapt Themselves to the Root Canal Anatomy 98</p> <p>4.1.4.5 Group 5: Engine-Driven Reciprocating Instruments 99</p> <p>4.1.4.6 Group 6: Sonic and Ultrasonic Instruments 99</p> <p>4.2 Properties of NiTi Alloys and Improvements by Thermomechanical Treatments 101</p> <p>4.2.1 Martensitic Transformation 101</p> <p>4.2.2 Pseudoelastic Properties 102</p> <p>4.2.3 Transformation Temperatures 104</p> <p>4.2.4 Manufacturing Processes 105</p> <p>4.2.5 Flexibility 109</p> <p>4.2.6 Clinical Implications 112</p> <p>4.3 Concepts in Root Canal Shaping 112</p> <p>4.3.1 Instrument Motions 113</p> <p>4.3.2 Canal Management Strategies 114</p> <p>4.4 Conclusion 124</p> <p>References 125</p> <p><b>5 Irrigating Solutions, Devices, and Techniques 133<br /></b><i>Christos Boutsioukis and Maria Teresa Arias-Moliz</i></p> <p>5.1 Introduction 134</p> <p>5.2 Irrigating Solutions 134</p> <p>5.2.1 Sodium Hypochlorite 134</p> <p>5.2.2 Chlorhexidine 136</p> <p>5.2.3 Ethylenediamine Tetraacetic Acid 136</p> <p>5.2.4 Citric Acid 137</p> <p>5.2.5 Etidronic Acid 138</p> <p>5.2.6 Maleic Acid 138</p> <p>5.2.7 Ozonated Water 138</p> <p>5.2.8 Electrochemically Activated Water 139</p> <p>5.2.9 Saline 139</p> <p>5.2.10 Mixtures of Irrigating Solutions 139</p> <p>5.2.10.1 BioPure MTAD 140</p> <p>5.2.10.2 Tetraclean 140</p> <p>5.2.10.3 QMix 141</p> <p>5.2.11 Suggested Irrigation Protocol 141</p> <p>5.3 Irrigation Techniques 141</p> <p>5.3.1 Irrigant Delivery Techniques 142</p> <p>5.3.1.1 Syringe Irrigation 142</p> <p>5.3.1.2 Negative-Pressure Irrigation 147</p> <p>5.3.1.3 Combined Positive- and Negative-Pressure Irrigation 149</p> <p>5.3.2 Irrigant Activation and Agitation Techniques 149</p> <p>5.3.2.1 Ultrasonic Activation 149</p> <p>5.3.2.2 Sonic Agitation 152</p> <p>5.3.2.3 Laser Activation 154</p> <p>5.3.2.4 Manual Dynamic Agitation 156</p> <p>5.3.3 Combinations of Techniques 156</p> <p>5.3.3.1 Continuous Irrigant Delivery and Ultrasonic Activation 156</p> <p>5.3.3.2 Continuous Irrigant Delivery and Multisonic Activation 157</p> <p>5.4 Final Remarks 158</p> <p>References 159</p> <p><b>6 Root Canal Filling Materials and Techniques 181<br /></b><i>Bun San Chong and Nicholas Chandler</i></p> <p>6.1 Introduction 182</p> <p>6.2 Root Canal Obturation Materials 182</p> <p>6.2.1 Sealers 182</p> <p>6.2.1.1 Zinc Oxide-Eugenol Sealers 183</p> <p>6.2.1.2 Calcium Hydroxide Sealers 184</p> <p>6.2.1.3 Glass Ionomer Sealers 185</p> <p>6.2.1.4 Resin Sealers 186</p> <p>6.2.1.5 Silicone Sealers 187</p> <p>6.2.1.6 HCSC Sealers 187</p> <p>6.2.1.7 Other Sealer Types 190</p> <p>6.2.2 Core Materials 190</p> <p>6.2.2.1 Silver Points 190</p> <p>6.2.2.2 Acrylic Points 191</p> <p>6.2.2.3 Gutta-Percha 191</p> <p>6.3 Root Filling Techniques 193</p> <p>6.3.1 Cold Gutta-Percha Condensation Techniques 194</p> <p>6.3.1.1 Lateral Condensation 194</p> <p>6.3.1.2 Single-Cone Obturation 195</p> <p>6.3.2 Heat-Softened Gutta-Percha Techniques 196</p> <p>6.3.2.1 Intracanal Heating Techniques 197</p> <p>6.3.2.2 Extracanal Heating Techniques 198</p> <p>6.3.3 Thermomechanical Compaction 199</p> <p>6.3.3.1 Vibration and Heat 199</p> <p>6.3.3.2 Rotating Condenser 199</p> <p>6.3.4 Other Obturation Techniques 200</p> <p>6.3.4.1 Pastes 200</p> <p>6.3.4.2 HCSCs 201</p> <p>6.3.4.3 Monoblocks 202</p> <p>6.3.4.4 Hydrophilic Polymers 202</p> <p>6.4 Orifice Barrier Materials and Tooth Restoration 203</p> <p>6.5 Retreatment 203</p> <p>6.6 Conclusion 205</p> <p>References 205</p> <p><b>7 Root-End Filling and Perforation Repair Materials and Techniques 219<br /></b><i>Josette Camilleri and Christof Pertl</i></p> <p>7.1 Introduction 219</p> <p>7.2 The Surgical Environment 220</p> <p>7.3 Materials for Endodontic Surgery 224</p> <p>7.3.1 Conventional Materials 224</p> <p>7.3.1.1 Zinc Oxide-Eugenol Cements 225</p> <p>7.3.1.2 Glass Ionomer Cements 228</p> <p>7.3.1.3 Filled Resin and Dentine Bonding Systems 231</p> <p>7.3.1.4 Other Materials and Techniques 233</p> <p>7.3.2 Hydraulic Cements 233</p> <p>7.3.2.1 Portland Cement-Based Hydraulic Cements: Types 1–3 234</p> <p>7.3.2.2 Tricalcium Silicate Cement-Based Hydraulic Cements: Types 4 and 5 245</p> <p>7.4 Conclusion 248</p> <p>Acknowledgements 248</p> <p>References 248</p> <p><b>8 Materials and Clinical Techniques for Endodontic Therapy of Deciduous Teeth 263<br /></b><i>Nastaran Meschi, Mostafa EzEldeen, Gertrude Van Gorp, and Paul Lambrechts</i></p> <p>8.1 Introduction 263</p> <p>8.2 The Primary Dentine–Pulp Complex 264</p> <p>8.3 Pulp Treatments in Deciduous Teeth 264</p> <p>8.3.1 Vital Pulp Therapy 264</p> <p>8.3.1.1 Incomplete Caries Removal 264</p> <p>8.3.1.2 Complete Caries Removal 266</p> <p>8.3.1.3 Restorative Materials for VPT of Deciduous Teeth 267</p> <p>8.3.2 Pulpectomy 275</p> <p>8.3.2.1 Technique 275</p> <p>8.3.2.2 Restorative Materials 278</p> <p>8.4 Conclusion 280</p> <p>References 280</p> <p><b>9 Adhesion to Intraradicular and Coronal Dentine: Possibilities and Challenges 289<br /></b><i>Mutlu Özcan, Claudia Angela Maziero Volpato, and Luiz Fernando D’Altoé</i></p> <p>9.1 Introduction 289</p> <p>9.2 Adhesion to Human Dentine 290</p> <p>9.3 Adhesion to Root Dentine in Vital Teeth 292</p> <p>9.4 Pulp Protection Materials and Their Effect on Adhesion to Dentine 293</p> <p>9.5 Adhesion to Root Dentine in Nonvital Teeth 294</p> <p>9.6 Conclusion 298</p> <p>References 298</p> <p>Index 305 </p>