In root canal surgery and perforation repair, the retrofilling material should seal the apex against diffusion of bacterial products from the root canal system into periradicular tissues and result in tissue healing. Several materials have been used for root-end filling. In this study the chemical compositions of two Iranian root-end filling materials, called Cold Ceramic and CEM Cement, were compared.

In this descriptive in vitro study, the X-ray fluorescence (XRF) and x-ray diffraction (XRD) methods were used for structural analysis and quantification of elements and components of the two materials. One cold ceramic sample and two CEM cement samples (produced in two different years with different batch numbers) were examined. A total of 3.5 g of each sample powder were homogenized, smashed in the form of pills and analyzed by the XRF and XRD. Data were collected and analyzed by Fisher's exact test (α=0.05).

The results of XRD showed that Cold Ceramic and CEM Cement are similar in major phases, consisting of larnite, barite and calcium silicate. The results of XRF showed no significant differences between the elements and chemical compositions of Cold Ceramic and CEM Cement. There were differences in the Zn, Zr and P contents between the two products.

Given the similarities in the structural elements and compounds of Cold Ceramic and CEM Cement as demonstrated in this study, it seems that CEM Cement has physical and chemical properties similar to those of Cold Ceramic.

The need to use a highly effective sealer in order to create a complete seal along the canal is essential for the basic treatment of tooth roots. Therefore, the aim of this study was to investigate the sealing ability of cold ceramic and gutta-percha with sealer by applying the bacterial leakage and electrochemical method.

In this in-vitro experimental study, fifty human single-rooted teeth were selected and their crowns were cut from the cervical region. The canals were prepared and washed with 17% EDTA. Then the teeth were randomly divided into four groups: group 1 gutta-percha with AH26 sealer (Dentsply Detrey, Germany) (n=20), group 2 cold ceramic (Yazd, Iran) (n=20), negative and positive control groups which each consisted of 5 teeth. Samples were kept in an incubator at 37° C for 48 hrs. Two coats of nail polish were used for covering the root, except for the last 2 mm, and microleakage in the fillings was measured by the bacterial leakage and electrochemical methods. The microleakage of the two groups was statistically analyzed in the electrochemical technique by Student's t-test, and in the bacterial leakage method by Fisher's exact test.

In bacterial leakage method, in the first group (gutta-percha) 7 samples (35%) and in the second group (cold ceramic) 3 samples (15%) had bacterial leakage, but no significant difference was observed between the two groups on different days (P>0.05). The mean microleakage based on the electrochemical technique in gutta-percha was significantly higher than that of cold ceramic (P=0.0001).

According to the lower microleakage values in the use of cold ceramic compared to gutta-percha, cold ceramic  can be used to fill root canals to reduce microleakage, although further studies are needed.

Materials used for root filling include cold ceramics, gutta percha and endoseal MTA. In this study, our aim is to investigate and compare the marginal adaptation of channels filled with cold ceramic and gutta percha - endoseal MTA.

In this experimental laboratory study, 20 extracted human single-rooted teeth were used. After canal preparation, the teeth were divided into two equal groups including 10 teeth. In the first group, cold ceramics were prepared according to the manufacturer's instructions and compacted inside the channels. In the second group, they were filled with gutta-percha and endosyl sealer MTA by lateral compression method. After one week, cross-sectional incubation was performed on the samples at 3 mm and 6 mm end to obtain a thickness of 3 mm and the maximum gap in microns between the root and wall fillers in the cross section directly by electron microscopy. Material / dentin contact was measured by Pearson, Spearman, and t-test.

The mean distance between root and tooth filling materials in the cold ceramic group was4.96±2.87 microns and in the second group was 12.03 ± 5.22 microns, which was statistically significant (P = 0.001).

In root canal filling, the degree of edge alignment in teeth filled with cold ceramics is significantly lower than that of gutta percha and endothelial sealant MTA.

 Apexification with calcium hydroxide is the traditional method to create an apical seal in open-apex teeth. Recently, single-visit apexification with suitable materials has gained popularity. A material suggested for this aim should have low solubility, low toxicity, and biocompatibility, and induce a calcified barrier and regenerate bone and PDL. Cold ceramic, introduced as a root-end filling material, has exhibited favorable properties for apexification in previous studies.

This case report describes successful apexification of a maxillary right central incisor in a 10-year-old girl with cold ceramic. One- and two-year follow-ups showed resolution of the lesion, absence of any clinical signs, new PDL formation, and bone regeneration.

 According to the results, cold ceramic can be considered an effective material for apexification.

The primary goal of endondtics is to prevent the spread of bacteria from the root canal to periapical space; therefore, the sealing ability of root canal filling material is of utmost importance. Cold ceramic is a relatively new retrofilling material which has demonstrated good sealing ability and acceptable criteria as root canal filler in previously conducted studies.

This case report describes the treatment and 2‐year follow‐up of a mandibular first molar which was filled with cold ceramic in a 42-year-old man. The treated teeth were asymptomatic, and the lesion was resolved after two years.

As evidenced by the obtained results, cold ceramic can be considered an effective material to promote the regeneration of apical tissue and root canal treatment.

Nowadays, in the treatment of necrotic teeth with open apex, based on the availability of bioceramic biomaterials with the ability of calcified tissue induction on cement and bone and periodontal ligament repairment stimulation using these materials has become more acceptable than the traditional calcium hydroxide apexification method. Cold ceramic is one of these bioceramics that in previous studies has shown successful results in the treatment of apexification.

Case Report:

 This article was a report of a successful case of apexification with cold ceramic and 10-months follow up of second mandibular molar tooth of a 14-year-old girl. In 10-month-old follow up, the tooth was asymptomatic and the periapical lesion healed after 10 months.

: It seems that cold ceramic could be used as a desirable material in the treatment of apexification and to strengthen the regeneration of periapical tissue.

The aim of this study was to investigate the tooth discoloration caused by cold ceramic compared to MTA Angelus in contact with the washing solutions such as sodium hypochlorite (NaOCl) and normal saline.

50 samples of extracted human maxillary anterior teeth were selected. After preparing the access cavity, they were divided into 4 experimental groups and 1 control group (10 in each group). The access cavities of teeth in groups 2 and 4 were rinsed with 5.25% sodium hypochlorite and those in groups 1 and 3 were rinsed with normal saline. Then, after drying, 3 mm thickness of cold ceramic (groups 1 and 2) and MTA Angelus (groups 3 and 4) were placed in the access cavities of the teeth. After setting of the materials, all specimens were restored with a resin modified glass ionomer. Based on the CIE Lab system, each sample’s total color change (∆E) was obtained before, one, and 90 days after application. Data were statistically analyzed using the Wilcoxon test.

According to the results, there was no statistically significant difference in the average tooth discoloration between the groups filled with cold ceramic and in different time periods (P>0.05). While, in the groups filled with MTA Angelus, the difference in the average tooth discoloration in 90 days after application was significantly higher than one day (P<0.05).

The results of this study showed that compared to MTA Angelus, cold ceramic causes less tooth discoloration over time and therefore, it can be suggested as a more suitable alternative endodontic cement than MTA Angelus.