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. Root Canal Sealer. Functions or roles of root canal sealers as antimicrobial agent
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Root Canal Sealer
G.V.Black Dental Center
Non- eugenol Root Canal Sealers
Medicated Root Canal Sealers
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
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-
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.
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
Zinc Oxide Eugenol - based Sealers
PCS regular& Extended Working Time PCS EWT
zinc oxide 34---41.2 %
precipitated silver 25-30 %
Oleo resins 30-16%
Thymol iodide 11-12%
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
4- greater bulk than any sealer –this is ideal
for condensation techniques
Disadvantages-- staining of the tooth --rapid setting time in high
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
Grossman's sealer ( 1958)
Composition : powered –zinc oxide 42 staybelite resin 27 bismuth subcarbonate 15
Barium sulfate 15 sodium borate 1 part
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
a nonstaining sealer
Marketed as a two-paste system
contains barium sulfate as a radiopacifier
Oil and Waxes
setting time glass slab 20 minutes root canal 5 minutes.
the manufacturer’s description,
Enoxolone 1%, Diiodothymol, Zinc oxide,
Radio-opacifier: silver powder.
- 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
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
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
If no water is added, the working time is approx. 3 hours.
The addition of water markedly reduces this time span.
Calcium salts (hydroxide, oxide, phosphate), hydrogenized
colophony, disalicylate, bismuth salts (oxide, carbonate),
highly dispersed silicon dioxide (silanized) and alkyl ester of
– Retrograde obturation
– Do not use Apexit Plus in patients with a known allergy
to any of the product’s ingredients.
Avoid contact of Apexit Plus with the skin mucous
membranes and the eyes. Unset Apexit Plus may cause
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.
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
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
SealApex (Sybron Endo/Kerr; Orange, Calif.)
calcium hydroxide–paste to paste System.
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
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.).
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
Paste B – adamantaneamine-N,N-Dibenzyl-5-oxanonane-diamine- 1,9,TCD-diamine
- Calcium Tungstate-Zirconium Oxide-Silica-Silicone oil
Urethane Dimethacrylate –base Sealers
Resilon ( Epiphany-Pentron Clinical Technologies-RealSeal, SybronEndo)
Developed to replace gutta percha and traditional sealers for root canal treatment
- Silane-treated barium borosilicate glass,
-bisthmus oxychloride with amines,
-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.
Glass ionomer –based Sealer
Ketac-Endo (3M/Espe; Minneapolis, Minn.)
Ease of manipulation radiopacity,
Best bond to dentin,
Lowest surface tension,
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 .
ProRoot MTA: (Dentsply)
Mineral Trioxide Aggregate - developed by Dr. torabinejad 1903 USA
white & Grey color
Grey --- Tricalcium Silicate
White ---- same as grey color except
lack of tetracalcium alumino-ferrite
-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
- it set in a moist environment (hydrophilic in nature –love of water)
- low solubility -resistant to marginal leakage
- 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.
Disadvtages : - Difficult to manipulate
- long setting time
Indication of use : - Apexification
- Root resorptions
- Root perforations
- Pulp capping
- Root end filling material ( grafting endodontic)
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.
1- fast setting may lead to cracks in side the hardened
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.
Nano-sized bioceramic sealer
iRootSP(Innovative BioCreamix Inc, Vancouver, Canada)
According to the manufacturer
aluminum-free sealer based on a calcium silicate composition,
- calcium phosphate,
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
-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
- Tricalcium Silicate
- Dicalcium Silicate
- Tantalum Pentaoxide
iRoot® BP is packaged in a
preloaded syringe and is supplied with disposable tips
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.
Tricalcium silicate, Dicalcium silicate, Amorphous silicon oxide, Tantalum pentoxide, Calcium Phosphate monobasic
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.