Root Canal Sealer

1. بسم الله الرحمن الرحيم G.V.Black Endo-Club Root Canal Sealer Dr. A.M.Badraldin G.V.Black Dental Center Khartoum-Sudan Jully-2009 www.gvblack-krt.com

2. Root Canal Sealer • Functions or roles of root canal sealers • as antimicrobial agent • fill the discrepancies between the obturation materials and dentin walls • as binding agent • As lubricant • Give radiopacity • As canal obturating material • Classification of root canal sealers • 1-Sealers may be classified according to their composition (Ingle) • Eugenol • Non-eugenol • Medicated • Eugenol Root Canal Sealers • Basically the eugenol group may be divided into subgroup namely • a-silver containing • b - silver free • --- silver containing cements • Kerr sealer ( Rickert,1931) • -- Silver free cements • Grossman's sealer Tubliseal Wash's paste www.gvblack-krt.com

3. Root Canal Sealer Non- eugenol Root Canal Sealers • Calcium Hydroxide –based Sealers SealApex,Apexit,Vitapex • Resin-based sealer AH26,AHPlus,Epiphany, Diaket • Solvent – based Sealers Chloropercha and eucapercha • Nogenol –based Sealer • Glass –ionomer-based sealers Ketac-Endo • Polycarboxylate-based sealers • Silicone-based Sealers Lee Endo-Fill, GuttaFlow • Calcium phosphate-based Sealers • Urethane Methacrylate - Based Sealers EndoRez • MTA-based Sealers ProRoot MTA • root canal sealers have therapeutic properties-usually • Used without core materials—Iodoform- disadvantages –compact root canal filling • Endofill • N2 • Endomethasone • Iodoform paste Medicated Root Canal Sealers www.gvblack-krt.com

4. Root Canal Sealer 2-Classification According to the intended use (Cohen,ADA) Type 1 Material's intended to be used with core material. Type 2 intended for with or without core material or seal Type 1: Divided into three classes Class1 – includes materials in the form of powder and liquid that set through a non polymerizing process. Class2 ---- include materials in a form of two pastes that set through a non polymerizing process. Class3---- includes polymers and resin systems that set through polymerization. Type 2 : divided into four classes Class1– powder and liquid non polymerizing. Class2– paste and paste non polymerizing. Class3-- metal amalgam. Class4 – polymer and resin systems- www.gvblack-krt.com

5. Root Canal Sealer Ideal properties for endodontic sealers 1. Adequate consistency and adhesion to dentinal walls. Tacky when mixed Only polycarboxylates and glass ionomers satisfy requirement No.1, good adhesion to dentin 2. Adequate working time. set slowly. Sodium borate 3. Capacity to produce a hermetic seal. 4. Easy handling. 5. Radiopacity provided by salts of heavy metals and a halogen: lead, silver, barium, bismuth, or iodine. 6. No shrinkage at the time of set. “significant dimensional change and continued volume loss can occur in some endodontic sealers. ZOE sealers begin shrinking “within hours after mixing AH-26…first expanded and showed no shrinkage for 30 days 7. Antibacterial action. www.gvblack-krt.com

6. Root Canal Sealer 8. Biocompatibility. Tissues tolerant (biotolerant) accept something; tending to withstand or survive. Bioactive. materials capable of interacting with living tissue 9. Insolubility in tissue fluids 10.To allow retreatment of the canal. 11. Do not discolor dental tissues zinc oxide–eugenol ,Endomethasone, and N2 induced a moderate . orange-red stain, Diaket and Tubli-Seal caused a mild pink discoloration AH-26 gave a distinct color shift toward grey. Cavit produced a light to moderate yellowish/green stain. gutta-percha caused a mild pinkish tooth discoloration AH-26 Silver-Free and Duo Percha induced a distinct color shift towards grey. 12. No antigenic action. not provoke Immune response. 13. No mutagenic or carcinogenic action www.gvblack-krt.com

7. Root Canal Sealers Zinc Oxide Eugenol - based Sealers PCS regular& Extended Working Time PCS EWT powder : zinc oxide 34---41.2 % precipitated silver 25-30 % Oleo resins 30-16% Thymol iodide 11-12% Liquid : oil cloves 78-80% Canada balsam 20-22% make the sealer tacky Advantages 1- excellent lubricating properties 2- working time more than 30 mints ratio 1:1 Completely set and become inert within 15-30min thus reducing the inflammatory responses compared to other That take 24-36hours to set EWT 6 hour working time 3- germicidal 4- greater bulk than any sealer –this is ideal for condensation techniques Disadvantages-- staining of the tooth --rapid setting time in high heat/humidity region www.gvblack-krt.com

8. Root Canal Sealers Zinc Oxide-Eugenol containing Sealers Setting reaction of zinc oxide eugenol Zinc oxide eugenol sets because of a combination of physical and chemical reaction, yielding hardening of the mixture is due to formation of zinc eugenolate the presence of free eugenol tend to weaken the set and increased the cytotoxicity. Practically all ZOE Sealer Cements are cytotoxic and invoke an inflammatory response in connective tissues. Advantages—ease of manipulation- plasticity - radiopaque with some germicidal properties- minimal staining –accepted working time, low setting time in the absence of moisture. good sealing properties. Disadvantage- irritation & not easily absorbed from periapical tissues. Zinc eugenolate has the disadvantage, however, of being decomposed by water through a continuous loss of the eugenol. This makes ZOE a weak, unstable material and precludes its use in bulk, such as for retrofillings placed apically through a surgical approach. Kerr– Pulp Canal Sealer (Ricket‘s Formula) -The initial ZOE Cement, developed by Rickert(1931) -The silver, added for radiopacity, causes discoloration of the teeth, thus creating an undesirable public image for endodontic. www.gvblack-krt.com

9. Root Canal Sealers Grossman's sealer ( 1958) Composition : powered –zinc oxide 42 staybelite resin 27 bismuth subcarbonate 15 Barium sulfate 15 sodium borate 1 part liquid eugenol Properties it has plasticity and slow setting time due to the present of sodium borate Disadvantages –present of resin need vigorous spatulation other with it lodge on the canal wall Roth's 801( Roth's Pharmacy-Chicago) Grossman original formula .Roth only add bismuth subniterate instead of bismuth subcarbonate www.gvblack-krt.com

10. Root Canal Sealers TubliSeal (SyberonEndo) a nonstaining sealer Marketed as a two-paste system Composition Base: Zinc Oxide Oloe Resin Bismuth trioxide contains barium sulfate as a radiopacifier Thymol iodide Oil and Waxes Catalyst: Eugenol Polymerized resin Annidalin setting time glass slab 20 minutes root canal 5 minutes. www.gvblack-krt.com

11. Root Canal Sealers • Advantages Tubliseal : • quick and easy mix and manipulation • extremely lubricated( Due to its lubrication property can be used when it is difficult to the master cone to Reach the last millimeter of preparation • does not stain teeth • expands after setting • Disadvantages • - Irritate periapical tissues • -very low viscosity easy extrusion through apical foramen • -short working time,rapid set especially in the presence of moisture (used when apical surgery is to Be performed immediately after filling) • The company has reformulated the sealer to extend working time, it now available in auto-mix tube Tubliseal Express www.gvblack-krt.com

12. Root Canal Sealers • tg sealer(Technical&General) • According to • the manufacturer’s description, • Zinc Oxide- Eugenol Root canal sealer • Powder: • Zinc oxide---- Thymol –iodide ---Barium Sulphate • Liquid: • Eugenol • Advantages • does not( irritate) periapical tissues • Contains antiseptic and anti-inflammatory additives • Does not stain the tooth structure • Good radiopacity • High adhesion properties (Fluid-tight seal, not hermetic seal) • Easy of manipulation & application • acceptable work time www.gvblack-krt.com

13. Root Canal Sealers • Endofill • According to • the manufacturer’s description, • Endofill is a radiopaque preparation for • permanent root-canal filling. • Its composition is well tolerated by tissues • and it provides anti-inflammatory, antiseptic • actions. Before hardening, the paste penetrates • the narrowest fissures and maintains its • therapeutic effects throughout the treatment • until completely set. The final • obturation neither retracts nor resorbs. • Endofill is available as REGULAR or SLOW setting • COMPOSITION • Powder :Dexamethasone Acetate 0.01%, • Hydrocortisone Acetate 1.0%, • Polyoxymethylene 2.2%, Thymol lodide 22.5%, • excipient ad 100% • Liquid :Eugenol www.gvblack-krt.com

14. Root Canal Sealers Sealite Ultra According to the manufacturer’s description, Powder: Enoxolone 1%, Diiodothymol, Zinc oxide, Radio-opacifier: silver powder. Liquid: Eugenol. PROPERTIES - SEALITE ULTRA contains Enoxolone): non steroidal anti-inflammatory agent with good local and systemic safety. It is used for the relief of post-operative pain following root canal. work cement witch perfectly fills even the smallest canals, very thin film thickness, no disintegration, very slow solubility, very high flexibility of handling, adequate working time and setting time www.gvblack-krt.com

15. Root Canal Sealers Zical According to the manufacturer’s description, Root Canal Sealant Based On Grossman's FormulaAntibacterial,non inflammatory * Root canal sealing using gutta percha points* Root canal sealing without using gutta percha points * Root canal filling for infected root canalsComposition:* Zinc Oxide * Bismuth Subcarbonate*Iodoform * Epoxy Resins* Barium Sulphate* Sodium borate Eugenol * Setting Time 5 - 10 Minutes* Working Time 4 - 6 SecondsProduct Benefits:* Antibacterial and non inflammatory* Based on Grossman's Formula* Radiopaque and non staining* Excellent thermal insulation www.gvblack-krt.com

16. Root Canal Sealers Calcium Hydroxide -Based Root canal Sealers Apexit & Apexit Plus ( Ivoclar-Vivadent) According to the manufacturer’s description insoluble, radiopaque calcium hydroxide cement for the permanent obturation of root canals in combination with gutta-percha points. It does not shrink during setting and demonstrates excellent physical and biological Properties Working Time If no water is added, the working time is approx. 3 hours. The addition of water markedly reduces this time span. Composition Calcium salts (hydroxide, oxide, phosphate), hydrogenized colophony, disalicylate, bismuth salts (oxide, carbonate), highly dispersed silicon dioxide (silanized) and alkyl ester of phosphoric acid. Contraindication – Retrograde obturation – Do not use Apexit Plus in patients with a known allergy to any of the product’s ingredients. www.gvblack-krt.com

17. Root Canal Sealers Side Effects Avoid contact of Apexit Plus with the skin mucous membranes and the eyes. Unset Apexit Plus may cause slight irritations. Interactions The setting time of Apexit Plus in the root canal is dependent upon the availability of moisture. The setting reaction can progress very quickly in canals which have been inadequately dried. The material begins to set at the apex, as dentin is thinnest in this region and the apical foramen admits additional moisture. Thus even when using Apexit Plus, make sure to thoroughly dry the root canal system prior to performing the obturation. Outside the mouth, on the mixing pad, Apexit Plus may remain soft for several days, depending on the ambient humidity The setting time of Apexit Plus is between two and five hours. In very dry canals, the setting time can be more than ten hours. www.gvblack-krt.com

18. Root Canal Sealers Further manipulation of the root canal system, such as the insertion of an endodontic post or an apicectomy should not be done prior to 24 hours following root canal obturation. Apexit Plus does not contain any pharmaceutical substances such as corticoids, antibiotics or formaldehyde-based preparations. Thus apical foci of inflammation are not masked by the antiphlogistic and immunosuppressive effect of these additives. To avoid postoperative sensitivity in the event of an infected canal, however, antibacterial root canal dressings should be placed prior to applying Apexit Plus. Should postoperative sensitivity occur, it should cease after a maximum of 48 hours. Apexit Plus differs from Apexit in that it is supplied in a more convenient delivery form and has a more hydrophylic formulation www.gvblack-krt.com

19. Root Canal Sealers SealApex (Sybron Endo/Kerr; Orange, Calif.) calcium hydroxide–paste to paste System. Base: zinc oxide, calcium hydroxide butyl benzene, sulfonamide zinc stearate. Catalyst : barium sulfate titanium dioxide as radiopacifiers resin, isobutyl salicylate, and aerocil. In 100% humidity, it takes up to 3 weeks to reach a final set. In a dry atmosphere, it never sets. the sealer expands while setting. Ingle question : Is SealApex soluble in tissue fluids to release the calcium hydroxide for its osteogenic effect? And if so, does this dissolution lead to an inadequate seal? LIFE (Sybron Endo/Kerr; Orange, Calif.) similar to SealApex Vitapex (NEO Dental, Japan) Contain 40% Iodoform Dentalis (DiaDent) Contain Iodoform& ZOE www.gvblack-krt.com

20. Root Canal Sealers Resins -Based Root Canal Sealers Based more on resin chemistry AH-26 (Dentsply/Maillefer, Tulsa, Okla) ----Shroeder 1957 an epoxy resin. It is a glue, the base is biphenol A-epoxy. The catalyst is hexamethylene–tetramine. It also contains 60% bismuth oxide for radiographic contrast. As AH-26 sets, traces of formaldehyde are temporarily released, which initially makes it antibacterial. AH-26 is not sensitive to moisture and will even set under water. It will not set, however, if hydrogen peroxide is present. Properties– good adhesive property- good flow –antibacterial -it contracts slightly while hardening Low toxicity and well tolerated by periapical tissues. -The addition of a hardener ,hexamethylene tetramine,make s the cured resin Chemically and biologically inert. the setting time is 36 to 48 hours at body temperature and 5-7 days at room temperature. The Swiss manufacturers of AH-26 recommend that mixed AH-26 be warmed on a glass slab over an alcohol flame, which renders it less viscous. AH-26 is also sold worldwide as ThermaSeal(Dentsply/Tulsa; Tulsa, Okla.). www.gvblack-krt.com

21. Root Canal Sealers AH PLUS Recognizing the advantages of AH-26 (high radiopacity, low solubility, slight shrinkage, and tissue compatibility) , as well as some of its disadvantages (formaldehyde release, extended setting time [24hours], and staining), the producers of AH26 set out to develop an improved product they renamed AH PLUS(Dentsply International). They retained the epoxy resin "glue” of AH26 but added new amines to maintain the natural color of the tooth. Its shade and color stability make it Material of choice where aesthetic demands are high. AH Plus comes in a paste–paste system, Paste A –epoxy resin -calcium tungstate -Zirconium Oxide -silica- -Iron Oxide Paste B – adamantaneamine-N,N-Dibenzyl-5-oxanonane-diamine- 1,9,TCD-diamine - Calcium Tungstate-Zirconium Oxide-Silica-Silicone oil www.gvblack-krt.com

22. Root Canal Sealers • Properties: • has a working time of 4 hours and a setting time of 8 hours. • half the film thickness and half the solubility of regular AH26 • , and may be removed from the canal if necessary. • In a comparative toxicity study, AH Plus was found to be less • toxic than regular AH-26. -Easy to mix • -adapts closely to the walls of the prepared root canal • -Provides minimal shrinkage upon setting • -outstanding long- term dimensional stability and sealing properties. • Calcium release is absent due to absent of release of calcium hydroxide • Durarte et al in 2003 Suggested addition of 5 percent • calcium hydroxide so it leads to low viscosity material • As well as it provides a more alkaline pH and calcium release. • This higher alkalinity And enhanced calcium release leads to • improved biological and microbiological behavior, as a more • alkaline pH favors the deposition of mineralized tissue and exerts an • Antimicrobial action. • AH Plus is also sold worldwide as • ThermaSeal Plu (Dentsply/Tulsa; Tulsa, Okla.)-Ingel-5 www.gvblack-krt.com

23. Root Canal Sealers Urethane Dimethacrylate –base Sealers Resilon ( Epiphany-Pentron Clinical Technologies-RealSeal, SybronEndo) Developed to replace gutta percha and traditional sealers for root canal treatment Contains -Urethane Dimethacrylate(UDMA) -Poly(ethylkene glycol)dimethacrylate(PEGDMA) -BisphenolA-dimethacrylate(BisGMA)resins - Silane-treated barium borosilicate glass, -Barium sulfate, -silica, -calcium hydroxide, -bisthmus oxychloride with amines, - peroxide, -photo inhibiter, pigments. designed for use with Polycaprolactone core material.Self-cures in about 25minutes. It comes with a self-etch prime. Sodium hypochlorite may negatively affect bond strength.the last irrigation should be EDTA& Sterile water or chlorhexidine. When obturation is completed ,the coronal surface may be Light-cured for 40 seconds to create coronal seal. www.gvblack-krt.com

24. Root Canal Sealers Glass ionomer –based Sealer Ketac-Endo (3M/Espe; Minneapolis, Minn.) Ease of manipulation radiopacity, Best bond to dentin, Fewest voids, Lowest surface tension, Best flow. Their greatest concern was the problem of removal in the event of re-treatment since there is no known solvent for glass ionomers . Experimental Sealer . www.gvblack-krt.com

25. Root Canal Sealers Ceramic-based Sealers MTA-based Sealers ProRoot MTA: (Dentsply) Mineral Trioxide Aggregate - developed by Dr. torabinejad 1903 USA Composition white & Grey color Grey --- Tricalcium Silicate Dicalcium Silicate Bismuth Oxide Calcium Sulfate Tetracalcium aluminoferrite White ---- same as grey color except lack of tetracalcium alumino-ferrite Properties: -setting time 2 hours and 45mihutes. - pH 12.5 when set so it has biological & histological properties Similar to calcium hydroxide. -high compressive strength and produces hard setting non Resorbable surface. - it set in a moist environment (hydrophilic in nature –love of water) - low solubility -resistant to marginal leakage www.gvblack-krt.com

26. Root Canal Sealers - biocompatible - the mixture is a loose granular aggregate, so it doesn't stick to any instrument( cement 0r amalgam carrier),unless compacted very lightly the loosely bong aggregate will be pushed out of the cavity. -Bacteriostatic Disadvtages : - Difficult to manipulate - long setting time - costly Indication of use : - Apexification - Root resorptions - Root perforations - Pulp capping - Root end filling material ( grafting endodontic) Precautions : 1-MTA material should be kept in closed container to avoid moisture 2- should be stored in dry area 3- material should be immediately placed after mixing to prevent dehydration during setting 4- working time is about five minutes, if more time working is need The mixed material should be covered by moist gauge to prevent evaporation Or add small drop of water during capillary condensation technique. www.gvblack-krt.com

27. Root Canal Sealers Bio-Dentine • - Septodont.. September 2010 • Based on Active borosilicate Technology • Tri-calcium Silicate core • Designed to treat damage dentine- both for restorative( pulp capping) • and endodontic indications( perforation & open apex .root canal repair material). • Advantages:- • - Biocompatible… eliminates the risk of adverse tissue response. • - Help to preserve pulp vitality by promoting reactionary dentine genesis • - reduce the postoperative sensitivity by its outstanding sealing properties. • - Easy to use – need no surface condition or bonding. • - compactable strength • - quick setting • Usage :- • - deep class V cavities - gross root caries • - restore endodontic - access cavities • - indirect pulp capping - open apex www.gvblack-krt.com

28. Root Canal Sealer Bio-Dentine Disadvantages:- 1- fast setting may lead to cracks in side the hardened biodentine 2-Have no long lasting antibacterial action (this action exist only during setting 10-12 m) Setting of biodentine is based on chemical reaction between CSC powder and CaCi2 which proceed fast. Slow setting ensures high pH which is maintained for along time.

29. Root Canal Sealers New www.gvblack-krt.com

30. Root Canal Sealers Nano-sized bioceramic sealer iRootSP(Innovative BioCreamix Inc, Vancouver, Canada) According to the manufacturer aluminum-free sealer based on a calcium silicate composition, Composition :- - calcium phosphate, -calcium silicates, -zirconium oxide, -calcium hydroxide. iRoot SP includes a similar composition to white mineral trioxide aggregate (MTA) iRoot SP can form a( hermetic) seal inside the root canal and be used for filling root canals with or without gutta-percha points., premixed, ready-to-use injectable white hydraulic cement paste developed for permanent root canal filling and sealing applications. iRoot SP is an insoluble, radiopaque, and aluminum-free material based on a calcium silicate composition, which requires the presence of water to set and harden. sealer is practically non resorbable bone-replacing bioceramic www.gvblack-krt.com

31. Root Canal Sealers Properties: -Potent antibacterial activ-ty, -absolute biocompatibility, -osseoconductivity, -ability to achieve excellent hermetic seal in constantly wet environment, -formation of chemical bond with dentin -insolubility in tissue fluids, -expansion during time of set, -very good radiopacity - easy handling iRootBP (Innovative BioCreamix Inc, Vancouver, Canada)iRoot® BP Injectable Root Canal Repair Filling Material (iRoot® BP) is a premixed injectable paste Composition: - Tricalcium Silicate - Dicalcium Silicate -Zirconium Oxide - Tantalum Pentaoxide -Calcium Sulfate iRoot® BP is packaged in a preloaded syringe and is supplied with disposable tips www.gvblack-krt.com

32. Root Canal Sealers BioAggregate® (Innovative BioCreamix Inc, Vancouver, Canada) a new generation of a dental root canal repair filling material.  BioAggregate® Root Canal Repair Filling Material (BioAggregate®) is a fine white hydraulic powder cement mixture for dental applications.  It utilizes the advanced science of nano-technology to produce ceramic particles that upon reaction with water produce biocompatible and aluminum-free ceramic material. Composition:- Tricalcium silicate, Dicalcium silicate, Amorphous silicon oxide, Tantalum pentoxide, Calcium Phosphate monobasic www.gvblack-krt.com

33. Root Canal Sealers Notes According to Innovative BioCreamix Inc, Vancouver, Canada) 1. During setting hard ceramic-based sealers expand. Expansion of BioAggregate and iRoot SP and iRoot BP is significant — 0.20% 2. Bioceramic-based sealers are capable of achieving fast alleviation of the pain in cases of acute periapical inflammation. After appropriate instrumentation and cleaning of the root canal, followed by immediate filling with iRoot SP, pain rapidly diminishes and most often is totally gone within a period of 50 minutes to few hours. In cases of MTA-based materials extrusion outside the root canal is associated with severe pain felt by the patient. When bioceramic-based sealers BioAggregate or iRoot SP are extruded, the pain is relatively small or totally absent. Such lack of pain may be explained with the characteristics of these new materials. During hardening they “produce” hydroxylapatite and after the end of hardening process they exhibit the same features as non-resorbable hydroxylapatite-based bioceramics used for bone replacement in oral surgery. Due to the hydroxylapatite formed, they are also osseoconductive 3. MTA-based materials and BioAggregate have quite poor radiopacity, different from bioceramic based iRoot SP and iRoot BP sealers. www.gvblack-krt.com