Gutta-Perch substitute Biocalex - Endocal 10 causes
Endocal 10, previously known as Biocalex, has
been used as a substitute for gutta-percha in endodontic obturation
. Although used for more than thirty years in Europe it has not
been popular in the United States. Endocal 10 was recently approved
by the FDA. Many dentists with holistic practices are using Biocalex/Endocal
as a substitute for gutta-percha citing the safety of the material
in terms of biocompatibility and allergic reactions.
A recent study had demonstrated that Endocal can,
if properly used, seal the root canal system as well as gutta-percha.
It has properties that are favorable: (1) diffusion into dentinal
tubules, (2) conversion to calcium hydroxide, (3) biocompatibility,
and (4) expansion upon setting to enhance the seal. These properties
are very advantageous, however, it is the expansion of the material
that is of concern. In the Goldberg study referenced
below, 20% of all specimens filled with Endocal resulted in root
fracture. This has long been known in the endodontic community
but never before published. In 2000, the American Association
of Endodontists published a position paper on Biocalex cautioning
users about the potential for root fracture.
Endocal 10 is calcium oxide combined
with zinc oxide in a solution of ethylene glycol and distilled
water. The calcium oxide combines with water to form calcium hydroxide.
This mixture expands upon setting and drives the mixture into
dentinal tubules and lateral canals. The study compared Endocal
10 and vertically compacted warm gutta-percha. There were no vertical
fractures in the gutta-percha group. Twenty percent of the Endocal
group fractured immediately after setting for 24 hours, then 7
and 10 days.
The rational for use of
non-gutta-percha materials is based on perceived biocompatibility
and allergenicity issues. As a result of the chemical similarity
between natural rubber latex and gutta-percha, questions have
arisen concerning the use of gutta-percha in patients with a history
of natural rubber latex allergy. Gutta-percha is a biologically
inert material that has demonstrated proven success when used
with an appropriate sealer to obturate root canals. Concerns of
allergic reaction to gutta-percha has been addressed in the recent
literature. A study published in 2001 reported no dectectable
cross-reactivity with gutta-percha products and natural rubber
latex. Only raw gutta-balata released proteins that were cross
reactive with Hevea latex. The authors concluded that the absence
of gutta-percha proteins that can react with Hevea latex specific
IgE antibody supports the minimal potential for commercially available
gutta-percha to induce allergic symptoms in individuals sensitized
to natural rubber latex.
As a commitment to delivering
the highest quality of endodontic treatment for your patients,
our practice will only use the safest and most scientifically
proven materials in our specialty. We do not recommend the use
of Biocalex/Endocal 10 as a substitute for currently proven endodontic
Goldberg RA, Kuttler S, Dorn SO.
The properties of Endocal 10 and its potential impact on the structural
integrity of the root. J Endodon 2004,30:159-162.
GE, Johnson JD, Hamilton RG. Cross reactivity studies of gutta-percha,
gutta-balata and natural rubber latex (hevea brasiliensis). J
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