Root canal sealers

JAGADEESH K P.G STUDENTDEPT. OF CONSERVATIVE DENTISTRY & ENDODONTICS

• SEALER, root canal (cement)-A radiopaque dental cement used, usually in combination with a solid or semi-solid core material, to fill voids and to seal root canals during obturation.

Glossary of Endodontic Terms

DEFINITION

Ideal Requirements

• Should provide an excellent seal apically and laterally.

• Should produce adequate adhesion when it sets.

• Should be radiopaque.

• Should be non staining.

• Should be dimensionally stable.

• Should be easily mixed and introduced in the r.c

• Should be easily removed if necessary.

• Be insoluble in tissue fluids.

• Should be bactericidal and non irritating

• should be slow setting to ensure sufficient working.

• Should not provoke an immune response on periapical tissues.

• Should not be mutagenic. - Cantatore

• a binding agent to cement the well fitted primary cone into a canal

• a filler for the discrepancies between the cone and the canal walls

• a lubricant to facilitate the seating of the primary cone into the

canal

• Radiopacity

• Certain techniques dictate the use of particular sealer

FUNCTIONS OF SEALERS

• Penetrate the patent dentinal tubules.

• Bind intimately to both the organic and inorganic phases of dentin.

• Neutralize or destroy microorganisms and their products.

• Predictably induce a cemental regenerative response over the apical

foramen.

• Strengthen the root system.

Future Directions

Type I: Sealer cements to be used with core materialsClass 1. Powder and liquid nonpolymerizingClass 2. Paste and paste nonpolymerizingClass 3. Polymer resin system

Type II: Filling materials to be used without core materials or sealer cementsClass 1. Powder and liquid nonpolymerizingClass 2. Paste and paste nonpolymerizingClass 3. Metal amalgamsClass 4. Polymers

CLASSIFICATION

Pastes

Plastics

Experimental sealers

INGLE

GROSSMAN

•Zinc oxide resin cements•Calcium hydroxide cements•Paraformaldehyde cements•Pastes

BASED ON COMPOSITION

COMPOSITION

Eugenol

Non eugenol

Medicated

EUGENOL

Silver containing cements

Kerr sealer (Rickert, 1931)

Procosol radio opaque silver cement (Grossman, 1936)

Silver free cementsProcosol non staining cement

(Grossman, 1958)

Grossman’s sealer (Grossman, 1974)

Tubliseal (Kerr, 1961)

Wach’s paste (Wach)

NON EUGENOLDiaket

AH 26

Chloropercha

Nogenol

Hydron

Endofil

Glass ionomer

Polycarboxylate

Calcium Phosphate cement

MEDICATEDDiaket A

N2

Endomethasone

SPAD

Iodoform paste

Riebler’s paste

Mynol cement

Ca(OH)2 paste

CLARKAbsorbable

eg: kerr sealer, grossman’s sealer, Roth’s cement

Non absorbableeg.: Diaket, ketac endo, AH 26/AH

plus

Based on principal ingredient present

Zinc oxide based

•Eugenol containing •Non eugenol containing

Iodoform based

•Iodoform based Vitapex

Polyacrylic based

•Polycarboxylate cement•Glass ionomer cement – Ketac endo

Calcium hydroxide based

Calcium hydroxide based

•Sealapex•CRCS•Apexit•Apexitplus•Vitapex

Resin based

• Polyvinyl resin based- Diaket- Diaket A

• Epoxy resin based- AH 26- AH plus

• Methacrylate resin based-Fiberfill-Hydron

-Epiphany

Silicone based• Lee Endofill• RoekoSeal• GuttaFlow

ZINC OXIDE BASED SEALERS

• Kerr’s Sealer or Rickerts’s formula (Dixon and Rickert 1931) POWDER LIQUID

Zinc oxide Oil of cloves

Precipitated silver Canada balsam

Resins

Thymol iodide

•ADVANTAGES:• Excellent lubricating properties

• Allows working time more than 30 min, when

mixed in 1:1 ratio

• Germicidal action and biocompatibility

• Greater bulk than any sealer..

•DISADVANTAGES:• Extremely staining

Manipulation:• Pellet contains powder and liquid in a bottle

• One drop of liquid to one pellet of powder

PROCOSOL RADIOPAQUE SILVER CEMENT(GROSSMAN, 1936)

POWDER LIQUID

Zinc oxide 45% Eugenol 90%

Precipitated Silver 17% Canada Balsam 10%

Hydrogenated resins 36%

Magnesium oxide 2%

PROCOSOL NONSTAINING CEMENT(GROSSMAN, 1958)

POWDER LIQUID

Zinc oxide 40% Eugenol 80%

Staybelite resin 27% Sweet oil of almond 20%

Bismuth subcarbonate 15%

Barium sulfate 15%

GROSSMAN’S SEALER

POWDER LIQUID

Zinc oxide 40 Eugenol

Staybelite resin 30

Bismuth subcarborate 15

Barium sulfate 15

Sodium borate 1

ROLE OF EACH COMPONENTS :-• Staybelite Resin:- improves mixing characteristics and retards the

setting time

• Sodium borate:- extends the setting time

• Bismuth subcarbonate, Barium sulfate:- improves Radiopacity

ADVANTAGES:-• It is the most widely used sealer

• Meets most of Grossman's own requirements for an ideal sealer

• It causes minimal degree of irritation and a high level of antimicrobial

activity

• This sealer is excellent when lubrication is needed.

• Cleans up nicely with xylene and other similar solvents.

• The formulation is nonstaining.

• The tissue toxicity is about the same as other ZOE-type

sealers

• It has good sealing potential and very small volumetric

change upon setting.

• It has increased plasticity and slow setting time, which is due

to the presence of sodium borate anhydrate

• It is used in many of the dental schools because it is

inexpensive and has a very slow -setting time of 8 to 12 hours.

• It has good sealing potential and very small volumetric change

upon setting.

• DISADVANTAGES

• Post fill sensitivity due to overextension into periapical tissue

may last longer due to its long setting time.

• zinc eugenate can be decomposed by water through a continuous

loss of eugenol, making zinc oxide-eugenol a weak and unstable

material.

MANIPULATION• Sterile glass slab and spatula

• Not more than 3 drops of liquid should be used at a time.

• Small increments of powder is added to liquid and mixed to a

creamy consistency.

• Spatulation time – 1 minute/drop

• The cement will not harden for 6-8 hrs if left on the glass slab.

• In the canal, because of moisture in the dentinal tubules, it begins

to set in half an hour.

TEST FOR PROPER CONSISTENCY• Drop test

• “String-out” test.

Roth’s sealer

• It is a substitution of bismuth sub nitrate for bismuth

subcorbonate .

• Roth’s 801 is an modern-day Grossman formula and its

newer version is Roth’s 811

WACH’S SEALER 

POWDER LIQUID

Zinc oxide 10g Cnanada balsam 20ml

Tricalcium phosphate 2g Oil of cloves 6ml

Bismuth subnitrate 3.5g

Bismuth subiodide 0.3g

Heavy magnesium oxide 0.5 g

Properties• Medium working time• Medium lubricating quality• Minimal periapical irritation• It is sticky due to the presence of Canada balsam • Increasing thickness of the sealer lessens its lubricating effect so it is indicated where there is possibility of over extension.

ADVANTAGES•  It is a good germicidal, relatively low tissue irritant .•  The sealer is biocompatible to the periapical tissue.

 DISADVANTAGES • Wach’s paste has medium working time and has less lubricating quality.

MANIPULATION 

• The sealer is supplied as powder and liquid separately. One

drop of liquid is used with an appropriate amount of powder.  

• Mixed to a creamy smooth consistency and should string out

atleast one inch when spatula is raised from the glass slab.

• Larger canals generally require a slightly thicker mix and also if

there is any chance of over extension.

TUBLISEAL

Base paste Catalyst pasteZinc oxide 57-59% Eugenol

Oleo resins 18.5-21.25% Polymerised resin

Bismuth trioxide 7.5% annidalin

Thymol iodide 3.75-5%

Oil and waxes 10%

MANIPULATION

Tubliseal sealer is contained in two collapsible tubes containing a

base and accelerator which when mixed together to about half an

inch (which is sufficient in most cases) forms a creamy mix.

ADVANTAGES • The sealer does not stain the tooth structures.

• It is extremely lubricating has a high rate of flow giving a

thinner film.

• Expands after setting

•DISADVANTAGES• very low viscosity -makes extrusion through the apical foramen

• The Tubliseal sealer is very irritating to the periapical tissue

• Short working time

•INDICATIONS

• When apical surgery is to be performed immediately after filling

• Because of good lubricating property, it is used in cases where it

is difficult for a master cone to reach the apical third of the root

canal.

Systemic Toxicity and Allergies of ZOE sealers

low systemic toxicity

Formaldehyde, which is released from ZOE sealers containing paraformaldehyde, is a known allergen (hapten) as well.Local Toxicity and Tissue Compatibility

Aspergillosis

A number of case reports document that paraformaldehyde-

containing ZOE sealers may cause an aspergillosis of the

maxillary sinus when the root canals of upper posterior teeth are

overfilled and the sealers are pressed into the maxillary sinus.

G. Schmalz Biocopatibility of dental materials

Antimicrobial Properties

NON-EUGENOL SEALER CEMENTS

KLOROPERCHA N – SEALER

POWDER LIQUID

Canada balsam 19.6% chloroform

Rosin 11.8%

Gutta percha 19.6%

Zinc oxide 49%

CHLOROPERCHA

Chloropercha is obtained by mixing gutta percha with

chloroform to fit better in the canal.

MODIFIED CHLOROPERCHA METHODS

1. Johnston-Callahan Method

• 95% alcohol

• Callahan resin Chloroform

2. Nygaard-Ostby Method

• Canada balsam, colophonium and zinc oxide powder mixed

with chloroform

• DISADVANTAGES OF CHLOROPERCHA• Chloro percha is carcinogenic

• Chloro percha products undergo shrinkage of during the

evaporation of chloroform.

• It acts as an irritant to the periapical tissues.

• Chloro percha has been shown to be associated with a

greater degree of leakage than other materials.

NOGENOL

This was developed to overcome the irritating quality of eugenol. The product is an outgrowth of a non-eugenol periodontal pack.

COMPOSITION BaseZinc oxide with barium sulfate as a raiopacifer along with vegetable oil. CatalystThe setting of the sealer is accelerated by hydrogenated rosin , chlorothymol and salicylic acid

  ADVANTAGES

• Nogenol is a less irritating sealer

• The sealer expands on setting and may improve its sealing

efficacy with time.

 

CALCIUM HYDROXIDE BASED SEALERS

• Herman – 1920

• First clinical use as root canal filling material – Rhoner

• BIOCALEX – French researchers (1950)

• Dycal as root canal sealer – 1970

The two most important reasons –

• Stimulation of the periapical tissues in order to maintain health /

promote healing

• Antimicrobial effects.

SEAL APEX

Noneugenol calcium hydroxide polymeric resin root canal sealer

Base Calcium hydroxide 25% Zinc oxide 6.5% Calcium oxide Butyl benzene Silicon dioxideCatalyst Barium sulfate 18.6% Titanium dioxide 5.1% Zinc stearate 1% Isobutyl salicylate Disalicylate Trisalicylate Bismuth trioxide

In 100% humidity, it takes three weeks to reach a final set. It never

sets in a dry atmosphere.

Advantages• It has good therapeutic effect and biocompatible

• The extruded material resorbs in 4-5 months

Disadvantages • Poor cohesive strength

• Takes long time to set (3weeks)

• Absorbs water and expands on setting

CALCIBIOTIC ROOT CANAL SEALER

Powder contains

Calcium Hydroxide

Zinc Oxide

Bismuth dioxide

Barium Sulfate Liquid contains

Eugenol

Eucalyptol

It contains 14% of available calcium hydroxide

Advantages• Biocompatible

• Takes three days to set

• Stable in nature

• Shows little water resorption

• Easily disintegrates in tissues

Disadvantages• Extruded sealer is resistant to resorption by tissue fluids

• It shows minimal antibacterial activity

APEXIT

Available in syringesCOMPOSITIONBase

Calcium hydroxide 31.9 %Zinc oxide 5.5 %Calcium Oxide 5.6 %

Silicon dioxide 8.1 %Zinc stearate 2.3 %Hydrogenised colophony 31.5 %Tricalcium phosphate 4.1 %Poly dimethyl siloxane 2.5 %

ACTIVATOR 

Trimethyl hexanedioldisalicylate 25.0 %Bismuth carbonate basic 18.2 %Bismuth oxide 18.2 %Silicon dioxide 15.0 %1,3 Butanediol di Salicylates 11.4 %Hydrogenised colophony 5.4 %Tricalcium phosphate 5.0 %Zinc stearate 1.4 %

AdvantagesBiocompatibleEasy to mix Radiopaque Hard setting

APEXIT PLUS

VITAPEX

IODOFROM , a known bactericide, is released from the sealer

RESIN BASED SEALERS

POLYVINYL RESIN BASED

DIAKET

• It is a polyvinyl resin (polyketone), a reinforced chelate formed

between zinc oxide and diketone.

•Schmidt in 1951.

POWDER LIQUID

Zinc oxide 2,2 dihydroxy- 5,5 chlorodiphenylmethane

Bismuth phosphate B-diketone

Triethanolamine

Caproic acid

Copolymers of vinyl chloride, vinyl acetate and

vinyl isobutyl

Advantages• Good adhesion• Fast setting• Stable in nature• Superior tensile strength

Disadvantages• Toxic in nature• Tacky material difficult to manipulate• If extruded fibrous encapsulation• Setting adversely affected by presence of camphor or phenol

DIAKET A• Chemically similar to Diaket but contains disinfectant Hexa Chlorophene

• One of the few medicated cement, does not contain paraformaldehyde

EPOXY RESIN BASED SEALERS

POWDER

Bismuth oxide 60%

Hexamethylene teramine 25%

Silver powder 10%

Titanium oxide 5%

LIQUID

Bisphenol diglycidyl ether

AH-26

Properties: Good flow Good adhesive property Antibacterial Contracts slightly while hardening Low toxicity and well tolerated

Advantages:• Not effected by moisture and will even set under water Setting time: 36-48 hours at body temperature 5-7 days at room temperature Greater adhesion to dentin Low solubility Tissue compatibility Slight shrinkage

Disadvantages:• Silver containing• Formaldehyde releasing

AH PLUS

PASTE A PASTE B

Epoxy resins Adamantianeamine

Calcium tungstate N,N- di benzyl-5- Oxanonane-diamine-

1,9,TCD-diamine

Zirconium oxide Zirconium oxide

Silica Silica

Iron oxide Silicone oil

Working time 4hrs

Setting time 8 hrs

Flow 36mm

Film thickness 26µ

Shrinkage 1.76%

Solubility 0.31%

AH 26 AH PLUS

1. Powder and liquid 1. 2 paste system

2. Releases small amount of formaldehyde on mixing, making it toxic in nature

2. Less toxic so biocompatible in nature

3. Causes tooth staining 3. Does not cause staining

4. Film thickness: 39µ 4. It is 20µ

5. Setting time :24- 36 hours 5. Setting time: 8 hours

6. Good radio opacity 6. Better radio opacity

7. Less soluble 7. Half solubility when compared to AH 26

EZ FILL

EZ FILL XPRESS

HYDRON

• Rapid setting hydrophilic, plastic material used as root canal sealer

without the use of a core.

• Wichterle and lim in 1960

• It is available as an injectable root canal filling material

• Polymer of hydroxy ethyl methacrylate

Advantages • A biocompatible material

• Conform the shape of the root canal because of its plasticity

METHACRYLATE RESIN BASED

Disadvantages• Short working time

• Very low radiopacity

• Irritant to the periapical tissues

• Difficult to remove from the canals

Endo REZ

• UDMA based• Bio compatible, Hydrophilic sealer

•ADVANTAGES• Radiopacity similar to G.P

• Good adaptation

• Good flow

• Remains soft and plastic for longer time

•DISADVANTAGES• Shelf life (18 months)

• Poor sealing in apical third

• Shrinkage (hammad et al 2008)

EPIPHANY

• self etch primer• sealer • core material (RESILON points)

• Claimed to achieve excellent seal by creating a MONOBLOCK Prior to the application of primer, 17% EDTA – smear layer removal Rinsing with saline or 2% CHX Primer with paper points Sealer mixed (dual syringe mixed with auto mixing tip) Applied into the canal using lentulo spiral or Master Cone

PROPERTIES• Highly radiopaque

• Easy to remove

• Dual curing, hydrophilic

• Biocompatible, nonmutagenic, and noncytotoxic

• Less irritating

• Improves the fracture resistance of the roots

MONOBLOCK

Franklin R. Tay J endo 2007

• The term monoblock, literally meaning a single unit.

• Monoblock concept is thearitically related to a genuine gap

free solid filling that is able to produce a real fluid tight seal

and improve fracture resistance of root.

• Development of true monoblock is the real challenging

• Using 3D-speckle interferometry - endodontic access preparation

– 0.24±0.03µm in intact roots to 0.36±0.04 µm.(3.75N).

• Tapered post space - 0.57±0.04 µm.

• parallel-sided post preparation - 0.73±0.09µm

PRIMARY MONOBLOCK

• HYDRON - 2-hydroxylethyl methacrylate (HEMA) – en

masse filling.

• HEMA polymerizes in the presence of water to form soft

hydrogels.

• Highly permeable and leachable & exhibited extensive

leakages.

• Modulus of elasticity hydron - 180 to 250 mpa.

MTA

• As an apexification material represents primary monoblock in

attempts to strengthen immature tooth roots.

• MTA is composed principally of Portland cement with the

addition of Bismuth trioxide to render it radiopaque.

• Being an entirely inorganic material, Portland cement undergoes

chemical shrinkage after hydration.

• Thus, a certain amount of volumetric shrinkage should also occur

during the setting of MTA.

• Not bonded to dentin - no shrinkage stresses.

• Calcium and hydroxyl ions of MTA + phosphate-containing

synthetic body fluid apatite-like interfacial deposits

(BIOLOGIC APATITE) –

Benham Bolhari et al JOE 2014

• Fill any gaps - improve the frictional resistance .

• Probably also accounts for the seal - in orthograde obturation.

• Although the elastic modulus of MTA is not available,

studies on Portland cements indicate that the compressive

elastic modulus of the latter is approximately 1.7 GPa (i.e.,

1700MPa) during the early setting stage.

• Unlike Hydron, MTA should theoretically be able to

strengthen roots.

Andreasen et al, - examined the fracture resistance of MTA

applied to immature sheep roots found no difference in roots that

were filled with Ca(OH)2 versus those that were filled with MTA.

The inability of MTA to strengthen roots is due to lack of bonding

to dentin & its low strength in tension.

Andreasen JO, Munksgaard EC, Bakland LK. Comparison of fracture

resistance in root canals of immature sheep teeth after filling with calcium

hydroxide or MTA. Dent Traumatol 2006;22:154–6.

SECONDARY MONOBLOCKS

• Secondary monoblocks have two circumferential interfaces, one

between the cement and dentin and the other between the cement

and the core material.

• Ability to bond strongly and mutually to one another as well as

substrate.

• Modulus of elasticity similar to that of substrate.

Cement Modulus of elasticity Von Mises stress

Panavia F 18.3 GPa 20.9 MPa

Zinc Phosphate cement

9.3–13.4 GPa 20.8 MPa

Superbond C&B 1.8 GPa 24.5 MPa

glass-ionomer cement

4.0 GPa 23.6 MPa

• As result use of resin composite luting cements has been

reported to reveal superior post retention, less solubility and

microleakage compared to zinc phosphate cements.

• The first implied existence of a mechanically homogeneous

monoblock in the root canal space was reported in 1996 with the

bonding of epoxy resin–based, carbon fiber–reinforced posts

to root dentin.

• Carbon fiber posts, having a modulus of elasticity very similar

to that of dentin, - achieve a tooth–post–core monoblock instead

of an assembly of heterogeneous materials.

• The beneficial claims of the carbon fiber post-root dentin monblock could not be validated in invitro and invivo studies.

• Epoxide ring opening and methacrylate grafting is not happened under physiological temperatures.

• Later on quartz coated carbon fibers and glass fibers that are amenable to silane coupling.

• Epoxy resin embedding is replaced with highly cross-linked, oxygen inhibition layer free methacrylate resin matrices.

• Although the use of newer generations of fiber posts have not attained ideal Monoblock, reported to have performed well invivo because of modulus of elasticity.

RESILON

• Initial studies on resilon favorable

• RMS

• Polymerisation shrinkage

• C-factor

• Degree of conversion

• Urethane dimethacrylate

• Phase seperation – not homogenously dispersed

TERTIARY MONOBLOCK

• Tertiary monoblocks - third circumferential interface is

introduced between the bonding substrate and the obturation

material.

• Fiber posts that contain either an external silicate coating or

unpolymerized resin composite for relining root canals that

are

too wide or not perfectly round for the fitting of conventional

fiber posts may be considered as tertiary monoblock.

Anatomic post system

EndoRez system

Activ GP

SILICONE BASED SEALERSROEKOSEAL• Composition – polydimethyl siloxane, silicone

oil, paraffin base oil, hexachloroplatinic acid, zirconium dioxide

Properties• Excellent flow• Insolubility • Dimensional stability – expands slightly (0.2%)• Extremely biocompatible, does not contain

eugenol • Highly radioopaque

ENDOFILL

• COMPOSITION

• The base of Endo-Fill is heavily loaded with bismuth sub nitrate as radio opacifier. Hence it is densely radiopaque. The active ingredients are hydroxyl terminated dimethyl poly-siloxane, benzyl alcohol and hydrophobic amorphous silica (10 to 30 milli microns particle size).

 • The catalysts are ethyl ortho silicate, poly dimethyl siloxane

and catalyst intermediate.

• Endofill, when set has a rubbery consistency. Initially the

manufacturer recommended that it be injected into the canal as

the sole sealer.

• This is remarkable in that Endofill is virtually nontoxic the

least irritating sealer on the market.

• When used properly as a sealer with gutta percha it is quite

similar to other sealers.

• ADVANTAGES • It is easy to prepare,• It has a adjustable working time, low viscosity and rubbery in

consistency. It is easy to remove as Gutta Percha. • DISADVANTAGES • The endofill cannot be used in the presence of hydrogen

peroxide and the canal must be absolutely dry.• It also shrinks upon setting, but has an affinity for flowing into

tubuli. 

GUTTA FLOW

• Prepared by mixing gutta percha powder (to a low grain size) into

the components of silicone sealer.

• Unidose capsule.

• Consisits of two components in one capsule that are activated

by compression.

• Mixed for 30 seconds in a standard triturator.

• Canal tip can be used to dispense.

• Working time: 15min.

• Setting time: 25-30min.

ADVANTAGES• Flowable , thixotropic

• Dimensionally stable

• Expands slightly

DISADVANTAGES• Larger armamentarium needed

GUTTA FLOW2

MEDICATED ROOT CANAL SEALERS

N2 •Sargenti and Ritcher

•Hydrocortisone or terra-Cortril

•Formaldehyde – prolonged fixation and antiseptic action

•Powder contains

- zinc oxide: 64.50% -zinc stearate: 0.074%

- paraformaldehyde: 5.710% -titanium oxide: 4.670%

- bismuth carbonate: 9.930% -bismuth nitrate: 14.90%

- ferric oxide: 0.040%

The liquid contains: 

- eugenol: 77.0%

- rose oil: 1.8%

- lavender oil: 1.2%

- peanut oil: 20.0%

TOXICITY Degree of irritation is severe with over filling , persisting

paresthesia

ENDOMETHASONE

Formulation very similar to N2

Powder (pink in color) liquid

Zinc oxide – 100 g eugenol

Bismuth subnitrate- 100 g

Dexamethasone – 0.019 g

Hydrocortisone - 1.60 g

Thymol iodide – 25 g

Paraformaldehyde – 2.20 g

ENDOMETHASONE N

GLASS IONOMER SEALER

KETAC ENDO

Adhesive qualityPowder• Calcium aluminium lanthanum fluorosilicate glass• Calcium volframate• Silicic acid• PigmentsLiquid• Polyethylene polycarbonic acid/maleic acid• Copolymer• Tartaric acid• water

Advantages• Optimal physical qualities

• Shows bonding to dentin

• Shows minimum number of voids

• Low surface tension

• Optimal flow propertyDisadvantages• Cannot be removed in the event of retreatment – no solvent

• Toronto/Osract group – chloroform and ultrasonic no.25 file

RECENT ADVANCES

CERAMICS-BASED SEALERS

Repair following Pulpectomy-Grossman endodontic practice 12th ed

‘Endodontic grafting’

Filling of the root canal with ceramic sealer, which due to its

osseoconductivity action promotes the physiological closure of

the canal by cementoid hard tissue, can be called “endodontic

grafting.” Such endodontic grafting can ensure the lasting root’s

health while it constantly remains in contact with body fluids.

- Deyan Kossev & Valeri Stefanov, ROOTS MAGAZINE 2009

Sealers for ‘endodontic grafting’Endodontic sealers that set hard and are stable in constantly wet

environment are :

a. Recently created calcium — silicate — phosphate- based

bioceramic nano-compositions — Bio-Aggregate, iRoot SP

and iRoot BP.

b. MTA-based products — “MTA — Angelus”,ProRoot MTA,

Aureoseal.

• ProRoot endo sealer

• MTA fillapex

• CPM sealer

• MTA Obtura

• MTAS experimental sealer

• F-doped MTA

MTA based Sealers

ProRoot Endo

Tricalcium silicate

Dicalcium silicate

Calcium sulfate

Bismuth oxide

Tricalcium aluminate

Viscous aqueous solution of water soluble polymer

Powder

Liquid

2 : 1

amorphous calcium phosphate like phase

carbonate apatite/ biologic apatite - Gadaleta 1991

• Cytotoxicity

• Pushout bondstrength

• microleakage

MTA FILLAPEX

CPM Sealer

• Presented as a white modified portland cement-based material,

most significant difference is the presence of calcium carbonate,

which intends to increase the release of Calcium ions and offer

good sealing properties, adhesion to dentinal walls, adequate flow

rate, and biocompatibilty.

MTA Obtura

Composition similar to grey MTA Angelus, consisting of

Portland cement clinker and bismuth oxide

MTAS Experimental sealer

• 80% white portland cement

• Zirconium oxide

• Calcium chloride

• Resinous vehicle

F-doped MTA cements

• Powder consists of white portland cement, bismuth oxide, anhydrite,

sodium fluoride.

• Liquid consist of Alphacaine solution.

• Expansion in water and PBS.

Herbal Sealer (Biosealer)

It is an experimental root canal sealer based on Copaifera

multijuga oil-resin.

• Powder- zinc oxide, calcium hydroxide, bismuth subcarbonate,

natural resin (rosin) and borax.

• Liquid - purified Copaifera multijuga oil-resin.

Nanoseal plus root canal sealer

It is made up of calcium phosphate hydroxyapitite

nanoparticles range from 40-60 nm. The rod shaped active

nanoparticles can penetrate the dentinal tubules & enter

accessory canals to ensure that all the spaces are effectively

sealed.

Hybrid root seal

Fourth generation self-adhesive dual-cure sealer, available in the

powder-liquid form. It is an insoluble, radiopaque material that can

be used either with resilon or Gutta-percha.

The liquid comprises of 4-META, monofunctional methacrylate

monomers and photo-initiators, while the powder consists of a

mixture of zirconia oxide filler, silicon dioxide filler and

polymerization initiators.

4-META is able to promote monomer diffusion into the

acid-conditioned and underlying intact dentin and produces

functional hybridized dentin with polymerization. The

formation of the hybrid dentin is the major mechanism of

bonding and also the high quality hybridized dentin resists

acidic challenges.

Placement of sealer

• Reamer : is twirled counterclockwise, pumped and wiped

against the walls

• Absorbent paper points or gutta percha : pumping

• Lentulo spiral: in a handpiece

Disadv: locking in canal.

• Ultrasonic file without use of a coolant

conclusion

The selection of a sealer is based on amount of lubrication

needed, the length of working time estimated, and the filling

material to be used .Furthermore the composition of the sealer

is important since the toxic components of a sealer may irritate

periapical tissues which compromise the success of the

endodontic treatment.

References

• Text book of endodontics – ingle

• Pathways of pulp- cohen

• Text book of endodontics- nisha garg

• Dental materials- S.Maha laxmi

• Text book of endodontics – Arnaldo castelluci

• Biocompatibilty of dental materials- G.Schmalz

• J Biomed Mater Res B Appl Biomater. 2008 Feb;84(2):430-5

• Oper Dent. 2005 Jul-Aug;30(4):533-9

• Monoblocks in endodontics – Franklin R.Tay et al JOE 2007

• k.mamootil & H.H.Messer IEJ 2007

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