This document discusses root end fillings, including what they are, why they are performed, how they are performed, materials used, and the advantages of laser use. Key points include: root end fillings seal the apical root canal after surgery to prevent reinfection; materials like MTA, Diadent Bioaggregate, and Super EBA have shown high sealing ability and biocompatibility; lasers like Er-YAG can help prepare cleaner cavities and surfaces, reduce microleakage, and improve healing when used for root end fillings. Further research on lasers and new materials may help improve root end filling outcomes.

2. What Is it ?!
• a filling placed in the apical part of a tooth
root to seal that
affected part of the root after surgical
intervention .

3. Also called
• Endodontic retro-grade filling

4. Why we do it ?!
• Objective of retrograde filling is to achieve
Tight obturation of the apical canal which is
needed to keep micro-organisms and their by-
products out of the peri-apical region

5. How to do ?!
• Flap
• Root apex or apeces removal
• Cavity preparation
• Application of root end filling material .
• Suture for 1ry intension

6. Flap

8. Indications of endo surgery
• Periapical pathosis
• Abscess drainage
• Failed endo ttt
• Anatomic variation e.g. dilacerations

9. Take care of …..
• Maxillary sinus outline .
• Periodontal status of the patient
• Patient medical history e.g. blood problems
• Proximity to nerves e.g. mental & mandibular
nerves .

10. • Laser could be used in REF as follow :
1- for root resectioning … Er-YAG , Nd-YAG are
the best
2- for sterilization of prepared cavity and
resected apex … Er-YAG , Nd-YAG
3- improve sealing of root end material
following its … Er-YAG , Nd-YAG , CO2

11. Root end preparation
• Class-I cavity measuring a depth of 2-3mm
along the longaxis of tooth
• An ultrasonic tip can be used to prepare a
cavity withoutrisk of perforation
• Er-YAG , Nd-YAG , Ho-YAG LASER could be used
for preparation and root apical resectioning (
Er-YAG produces cleaner resected suface with
less thermal damage if compared to Ho-YAG )

12. • CO2 show rougher surface and less favourable
marginal fit following CO2 laser treatment to
the use of continuous wave mode so it is not
used in root resectioning

13. Advantages of laser
• Improves the healing process
• Reduces the post operative discomfort
#N.B : conventional root end filling is faster and not
technique sensitive as in using laser for root end
filling

14. • Valuable in controlling the bleeding during
procedure .
• Sterilizes the resected root surface , so no
smear layer or debris left on the resected root
surfaces prepared using the Er:YAG laser for
example .

15. Requirements of filling material
• Seals all bacteria within the canal to prevent
leakage of bacteria & bacterial by products
• Non-toxic Non-cariogenic
• Biocompatible with the host tissue
• Dimensionally stable & Insoluble in tissue
fluids
• Easy to use
• Unaffected by moisture during setting

16. • no material has been found that fulfills all or
most of the properties for ideal retrograde
filling material

17. Different root end filling materials
• Metals : such as gold-foil, silver posts,
titanium screws, tin posts , amalgam (with and
without bonding agent) and gallium alloy are
some of the solid, commonly used retro-filling
materials

18. • Cements and sealers : such as ZnOE Cement,
Super EBA , Diadent BioAggregate (DBA), ,
zincpolycarboxylate , zinc phosphate and glass
Ionomer cements, mineral trioxide aggregate
(MTA ) , calcium phosphate cement and bone
cement have also been employed for retro-
filling

19. • Mineral trioxide aggregate (MTA),
• Discovered by Mahmoud Torabenigad Prof of
advanced endodotics Loma Linda univ.
California and produced by Dentsply .
• composed mainly of tricalcic silicate, tricalcic
alluminate(*) , bismuth oxide, is a particular
endodontic cement. It is made of hydrophilic
fine particles that harden in the presence of
dampness or blood. ( Set time 3 hrs new MTA
set in 12-18 mins ) ( 50Mpa -15Mpa ) (3P:1L )

20. •DiaDent Bioaggregate
• (DBA)
• Most biocompatible material
• It is a ceramic nanoparticle material
• Set time (4-72 hrs )

21. • SuperEBA™ is an all-purpose, alumina-
fortified ZO material P( 70% ZO , 30% alumina
) L(62.5 % EBA, 37.5% Eu ) The fast set has a
10-15 minute slab set, but a faster in the
mouth set of 4-8 minutes.

22. • An in vitro studies shows Significant difference
of sealing ability was found among diff.
cements and sealnts used for root end filling
DBA followed by MTA and super EBA showed
the highest sealing ability.

23. • Other commonly used materials : are
composite resin (with and without bonding
agent) and gutta-percha

24. Laser assisted root end filling studies
revealed that ….
• the erbium laser, used for apicoectomy, results
in a high success rate with considerable
benefit in terms of clinical outcome and
therapeutic success.
• that cavities prepared with Er:YAG laser have
significantly lower microleakage for all tested
root end filling materials.

25. • resected root apeces treated by laser are
more sterile and have higher degree of sealing
against micro organisms

26. Conclusion
• The endodontic surgeon should consider using
materials, which have been biologically and
clinically evaluated and which give evidence of
long term success

27. • the best technical sequences among the ones
• evaluated in this study to perform endodontic
surgeries:
1- apicoectomy with bur and treatment of apical
surface with Nd:YAG laser;
2- apicoectomy with bur, root-end cavity
preparation with ultrasound, filling with MTA,
and treatment of apical surface with CO2 laser;
3- apicoectomy with Er:YAG laser and treatment
of apical surface with Nd:YAG laser.

28. • Using Er-Yag laser in root end filling is very
beneficial and increases the success rate of
the procedure
• Er-YAG laser is superior to Nd-YAG , CO2 and
Ho-YAG laser for root end fillings because of
effecacy and less thermal damage
• Er-YAG laser could be used in all steps of REF

29. • Based on review of literature, it appears to
date that the existing root-end filling materials
do not possess ideal characteristics, but
studies have revealed that MTA , Diadent
BioAggregate (DBA) and Super EBA are
superior to other retro-grade filling materials

30. Recommendations
• Boost the Er-YAG laser to be widely used root
end filling procedures .
• further development of MTA to reduce the
long setting time and difficulty in
manipulation for use as a root-end filling
material
• further researches about Diadent
Bioaggregates .