The International Endodontic Market is flooded with a wide variety of materials and technologies, which are often difficult to navigate without proper professional training. Unfortunately, Russia today serves as a marketplace for outdated products marketed as “new and in demand in the West.”
In this note, I want to talk about Endomethasone, which enjoys immense popularity in Russia. Even in serious Russian endodontic publications such as "Endodontia Today", articles recommending its use are being published (e.g., Napolnikov L.V. Experience of preserving the causative tooth in cases of periostitis in outpatient conditions. // Endodontia Today. Vol. 4, No. 3–4, 2003).
So, what is Endomethasone? It is a zinc oxide-eugenol cement with added paraformaldehyde and steroids. Other global analogues include Riebler’s paste and N2.
A review of global literature provides the following facts:
Following that incident, the American Association of Endodontists (AAE) conducted a thorough review of paraformaldehyde-containing sealers, leading to the following modern recommendations:
Endodontic sealers containing paraformaldehyde must not be used, as they are unsafe (from a medico-legal standpoint, this means that a doctor who uses these materials may be stripped of their license).
These sealers can cause irreversible damage to periapical tissues, including:
Formaldehyde has been shown to migrate through the body and accumulate in organs such as the adrenal glands, kidneys, spleen, liver, and brain.
We hope that these facts make a compelling case to abandon the use of such a dangerous material and highlight the importance of studying up-to-date endodontic literature, which enables more informed decisions when choosing working materials and treatment systems.
In this note, I want to talk about Endomethasone, which enjoys immense popularity in Russia. Even in serious Russian endodontic publications such as "Endodontia Today", articles recommending its use are being published (e.g., Napolnikov L.V. Experience of preserving the causative tooth in cases of periostitis in outpatient conditions. // Endodontia Today. Vol. 4, No. 3–4, 2003).
So, what is Endomethasone? It is a zinc oxide-eugenol cement with added paraformaldehyde and steroids. Other global analogues include Riebler’s paste and N2.
A review of global literature provides the following facts:
- The material is highly toxic both in vitro (Spangberg & Langeland, 1973) and in vivo (Spangberg 1969, 1974).
- Paraformaldehyde causes coagulation necrosis, which reaches its peak within 3 days.
- The necrotic tissue becomes saturated with formaldehyde, resulting in very slow healing, which may take months.
- If infection enters the tissue during the leaching of formaldehyde, the inflammatory reaction can be severe — up to the development of osteomyelitis (Block et al., 1980; Araki et al., 1993; Spangberg, 1969, 1974).
- Allergic reactions to Endomethasone have also been reported (Polman & Ord, 1986; Fehr et al., 1992).
- Beyond strong cytotoxicity, formaldehyde is known as a mutagenic (Goldmacher & Thilly, 1983) and carcinogenic agent (Swenberg et al., 1980).
- Direct contact with a nerve can cause paresthesia. The most well-known case occurred in the USA: after root canal treatment of a lower seventh tooth, the patient developed permanent paresthesia of the mandibular nerve. As a result, a court awarded the patient $6,000,000 in damages.
Following that incident, the American Association of Endodontists (AAE) conducted a thorough review of paraformaldehyde-containing sealers, leading to the following modern recommendations:
Endodontic sealers containing paraformaldehyde must not be used, as they are unsafe (from a medico-legal standpoint, this means that a doctor who uses these materials may be stripped of their license).
These sealers can cause irreversible damage to periapical tissues, including:
- Destruction of connective tissue and bone,
- Severe pain,
- Paresthesia and dysesthesia of the mandibular and maxillary nerves,
- Chronic inflammation of the maxillary sinus.
Formaldehyde has been shown to migrate through the body and accumulate in organs such as the adrenal glands, kidneys, spleen, liver, and brain.
We hope that these facts make a compelling case to abandon the use of such a dangerous material and highlight the importance of studying up-to-date endodontic literature, which enables more informed decisions when choosing working materials and treatment systems.
