ENDOCEM ZrENDOCEM Zr is a next generation MTA with minimal discoloration and calcification. Its physical properties include enhanced esthetics with a tooth color formula; excellent sealing property and biocompatibility; less discoloration; and decreased calcification, optimized for partial pulpotomy of anterior teeth.
The first issue is that of compromised esthetics. There are numerous products that are alleged to be tooth colored formula MTAs which designed for use on anterior teeth. Many of these products do not meet expectations esthetically, 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, partial pulpotomy is often performed to ensure adequate thicknesses of MTA and the final restoration. When doing so, calcification of the root canal or pulp chamber ensues, problematic for future treatment.
CAUTION
1.
Application of direct occlusal force should be avoided because ENDOCEM Zr exhibits less tensile strength than conventional MTA.
2.
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.
3.
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.
4.
After ENDOCEM Zr application, sealing should be maximized according to clinician preference, such as condensing with the handle of a paper point.
5.
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, lasting approximately 1 month. (If problems are found on post-operative radiographs the clinician may prescribe anti-inflammatory analgesic drug and notify patient.)
6.
Unlike direct pulp capping, blood supply does play an important role in partial pulpotomy, and if it is judged that the blood supply is insufficient, the treatment should be completed by performing direct pulp capping.
7.
Once unsealed, ENDOCEM Zr must be used and discarded, as it may become denatured and result in failure.
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