Zinc oxide–eugenol (ZOE) paste has been used in dentistry for over a century, making it one of the most historically significant dental materials. Despite the emergence of bioactive and resin-based alternatives, ZOE continues to play a role in specific clinical situations due to its sedative, antimicrobial, and sealing properties.
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✅ Composition and Mechanism of Action
ZOE is formed by the reaction between zinc oxide powder and eugenol liquid, producing a chelate with the following properties:
▪️ Sedative effect on pulp tissue
▪️ Antimicrobial activity
▪️ Low thermal conductivity
▪️ Moderate sealing ability
However, eugenol’s biological activity is dose-dependent, and excessive exposure may cause cytotoxic and inflammatory reactions, particularly in permanent teeth.
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1. Temporary Restorations
ZOE is still widely used as a temporary filling material due to its ease of manipulation and soothing effect on the pulp.
2. Base or Liner (Selective Use)
In low-stress situations, ZOE may be placed as a base under non-resin restorations, although its use has declined significantly.
3. Root Canal Filling in Primary Teeth
ZOE remains a traditional obturating material in primary teeth pulpectomies, especially when resorption compatibility is not critical.
4. Periodontal Dressings
Its anti-inflammatory and analgesic properties make ZOE useful in periodontal surgical dressings.
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Despite its historical importance, ZOE does not meet several modern biomechanical and biological standards:
▪️ Interferes with resin polymerization
▪️ Lacks bioactivity and regenerative potential
▪️ Limited mechanical strength
▪️ Potential cytotoxicity of eugenol
These limitations explain its progressive replacement by calcium silicate–based and resin-modified materials.
💬 Discussion
Contemporary dentistry prioritizes biocompatibility, bioactivity, and long-term stability. While ZOE provides short-term benefits, it does not promote dentin regeneration or pulp healing. Studies consistently show that materials such as MTA and Biodentine outperform ZOE in vital pulp therapies and permanent tooth applications.
However, eliminating ZOE entirely is neither realistic nor necessary. Its value lies in specific, well-defined indications, especially in temporary and pediatric applications when used judiciously.
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▪️ Avoid ZOE under resin-based restorations
▪️ Use cautiously in primary teeth, considering resorption dynamics
▪️ Prefer bioactive materials for vital pulp therapy
▪️ Reserve ZOE for temporary or palliative purposes
▪️ Avoid direct pulp contact in permanent teeth
Clinical success depends more on indication than tradition.
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Zinc oxide–eugenol remains a useful material in modern dentistry when applied selectively and with biological awareness. While it no longer represents the gold standard for many procedures, its sedative and antimicrobial properties still justify its use in temporary restorations, periodontal dressings, and certain pediatric applications. Modern clinicians must balance historical reliability with contemporary evidence.
📊 Comparative Table: Zinc Oxide–Eugenol vs Contemporary Dental Materials
| Aspect | Advantages | Limitations |
|---|---|---|
| Zinc Oxide–Eugenol | Sedative, antimicrobial, easy handling | Interferes with resin bonding, low bioactivity |
| Calcium Hydroxide | Stimulates dentin bridge formation | High solubility, poor long-term seal |
| Mineral Trioxide Aggregate (MTA) | Excellent biocompatibility and sealing | High cost, difficult handling |
| Biodentine | Bioactive, fast setting, dentin substitute | Technique-sensitive, higher cost |
✔ American Association of Endodontists. (2020). Guide to clinical endodontics (6th ed.). AAE.
✔ Camilleri, J. (2015). Investigation of biodentine as dentine replacement material. Journal of Dentistry, 43(2), 140–146. https://doi.org/10.1016/j.jdent.2014.11.007
✔ Cox, C. F., Sübay, R. K., Ostro, E., Suzuki, S., & Suzuki, S. H. (1996). Biocompatibility of dental materials. Quintessence International, 27(8), 533–546.
✔ Torabinejad, M., & Chivian, N. (1999). Clinical applications of mineral trioxide aggregate. Journal of Endodontics, 25(3), 197–205. https://doi.org/10.1016/S0099-2399(99)80142-3
✔ Parirokh, M., & Torabinejad, M. (2010). Mineral trioxide aggregate: A comprehensive literature review—Part I. Journal of Endodontics, 36(1), 16–27. https://doi.org/10.1016/j.joen.2009.09.006
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