Continuation of root canal sealers

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Continuation of root canal sealers

  1. 1. Advantages 1. Good physical properties. 2. Good bonding to dentin. 3. Good flow properties. 4. Few voids. 5. Less cytotoxic Disadvantages: It cannot be removed in the even of re-treatment. However recent studies shown that GIC can effectively removed by chloroform solvent followed by 1 minute ultrasonic instrumentation. Polycarboxylate cement: Consists of modified zinc-oxide powder and an aqueous solution of polyacrylic acid. The cement has chelating action bonding to both enamel and dentin. Because of its adhesive property and antibacterial action of this cement has be tested as root canal sealer. However apical seal is found to be inferior to other materials. It exhibits an inflammatory response when extruded into periapical tissue.
  2. 2. Cyanoacrylic Cements: These are composite type polymers that can be polymerized to hard products by the use of basic inorganic material that also serves as filled. They have been reported to be bio-compatible but not in much use. Medicated cement: The medicated sealers consists of paraformaldehyde, iodoform, calcium hydroxide or other powerful antiseptics. They fail to provide a compact root canal filling, but prolonged therapeutic effect. Riebler’s paste : Paraformaldehyde based. Powder / Liquid formulations: Powder : Zinc oxide. Formaldehyde Barium sulphate. Phenol. Liquid: Formaldehyde Sulphuric acid. Ammonia Glycerine.
  3. 3. Mynol cement: Iodoform based Powder: Zinc oxide Iodoform Rosin Bismuth Subnitrate Liquid Eugenol Cresol Thymol These materials are used without core materials and are introduced into root canal by lentulospiral or some type of infection device. Paraformaldehyde containing paste exhibits severe inflammatory reaction and tissue necrosis. Hence it is used as a sealer is restricted. Paraformaldehyde N2 : Was introduced by Sargenti and Ritcher in 1961. Two type of N2 sealers were available initially i.e.: N2, Normally for root filling and N2, Apical as antiseptic medication.
  4. 4. Recently N universal a cement containing the feature of both N2 normal and N2 apical has been developed for endodontic use. Composition: Powder: Zinc oxide Lead tetraoxide Paraformaldehyde Bismuth subcarbonate Titanium dioxide Bismuth subnitrate Phenyl mercuric borate 68.51 gms 12 gms 4.70 gms-Antiseptic 2.60gms – Opacifier 8.40gms- Adhesion 3.70gms – Opacifier 0.05 gms - Antiseptic Liquid: Eugenol Oleum Roae Olum Lavandulae Corticosteroids are now added separately as hydrocortisone powder. Severe irritation is its major drawback of N2. Increased blood lead level absorbed after N2 insertion.
  5. 5. Endometasone : Powder / Liquid Powder: Zinc oxide Bismuth subnitrate Dexamethasone Thymol iodide Paraformaldehyde 100gms 100gms 0.019gms 25 gms 2.20gms Liquid Eugenol The powder is pink coloured and mixed with eugenol to thick consistency. It exhibits severe irritation and masks the inflammatory reaction. Therefore sometimes gives rise to pain after 6 to 8 hours of insertion. Spad : This material is advertised as a one visit non-irritant, radiopaque filler and sealer. It is a resorbinol formaldehyde resin supplied as a powder and 2 liquid. Powder : Zinc oxide 72.9gms Barium sulphate
  6. 6. Titanium dioxide Paraformaldehyde Hydrocortizone acetate Calcium hydroxide Phenyl mercuric borate Liquid L : (Clear liquid) Formaldehyde 87.00 gms Glygerin 13.00gms Liquid LD : (Red colour) Glycerine 55gms Resorcinol 25 gms Hydrochloric acid 20 gms Equal parts of the 2 liquids are mixed with powder. The essential reaction to form the resin is between the resorcinol and the formaldehyde. To take place this reaction and pH is essential which is provided by Hcl. The role of zinc oxide is to control the pH and to prolong the setting time. The setting time of SPAD is 24 hours, during which small quantities of formaldehyde gas is released.
  7. 7. Indications: 1. Pulpotomies in both deciduous and permanent teeth. 2. For the treatment of acute endodontic infections. 3. Teeth with periapical infections. When SPAD is used in the treatment of periapical infection, a small amount is intentionally introduced beyond the apex with the belief that the sterilizing effect helps healing. Calcium Hydroxide has been used in endodontics as a root canal filling material, in intracanal medicament or as a sealant in conjugation with solid core materials. Pure Ca(OH)2 can be used or can be mixed with saline solution, methylecellulose or anesthetic solution. However pH of all these mixtures has found to be between 12.5 to 14.5. The use of Ca(OH)2 paste, as a root canal filling material is based on the assumption that, there is formation of hard structure or tissue at the apical foramen. Ca(OH)2 neutralizes the acids produced by bacteria and thereby decreasing the osteoclastic activity. The activity of Ca(OH)2 stimulates the induction of alkaline phosphate thus forming the hard tissue. Ca(OH)2 sealers may contain soley of Ca(OH)2 or it is combined with zinc oxide. E.g., Sealapex, Apexit, CRCS. Procalex. Life Sealer 26.
  8. 8. Sealapex: Is a product of Kerr manufacturing company has been described as non eugenol Ca(OH)2 polymer resin root canal sealer. Composition : It is a 2 paste formulation. Base paste: Zno with Ca(OH)2 Butyl Benzine. Sulfonamide Zinc Stearite and sumicron silica. Catalyst Barium sulphate Titanium dioxide Isobutyl salysilate Acrocil R 972 Two pastes are dispensed equally on mixing pad and mixed to a smooth, uniform consistency. It never sets on dry atmosphere which makes the presence of moisture essential for setting of sealapex. In 100% it takes 3 weeks to reach a final set. Sealapex expands while setting. It is biocompatible and shows good osteogenic potential.
  9. 9. CRCS (Calcibiotic Root Canal Sealers): It is the first sealer of the Ca(OH)2 group. It is basically a zinc oxide eugenol eucolyptol sealer to which Ca(OH)2 has been added for its osteogenic effect. Composition : Powder / Liquid system). Powder : Zinc oxide Hydrogenated Rosin. Barium sulphate Calcium hydroxide Bismuth subcarbonate Liquid L : Eugenol Eucalyptol CRCS is mixed like any other powder-liquid sealers. It sets both in dry as well as wet conditions. It shows very negligible water sorption, hence more stable, when compared to sealapex and other resin based sealers. Biocalex : Is another Ca(OH)2 based sealer consists of :
  10. 10. Powder: Calcium hydroxide Zinc oxide Liquid : Glycol Water Powder and liquid when mixed to form a paste acts as both intracanal medicament and as a sealer. After placement in the prepared cavity, it expands to more than 6 times is original volume, penetrating into all parts of root canal system. Iodoform pastes : Is a resorbable paste used alone or in combination with other core materials. It consists of: 1. 60 parts of iodoform. 2. 40 parts of solution of Parachlorophenol 3. 49% Camphor (antiseptic solution). 4. 6% menthol (antiseptic solution). Iodoform paste is intentionally placed beyond the apex to stimulate the inflammatory reaction, the end result of which is repair. It also
  11. 11. accelerates the bone formation. The paste in periapical region is removed by phagocytic action and slowly disappears with time. The disadvantage of iodoform paste is that it induces severe inflammatory reaction and with time discoloration, the tooth if not removed from the pulp chambers. The introduction of iodoform paste into the root canal may lead to rise in the iodine level in blood, hence contraindicated in patients who are sensitivity to iodine. Newer sealers: 1. Endofloss. 2. Appetite Root canal sealer. 3. Root canal sealers containing Tetra-calcium – Dicalcium phosphate and 1% chondrotin sulphate. Endofloss: Endofloss is a sealer consisting of powder liquid formulation. Powder: Zinc oxide. Iodoform Calcium hydroxide. Barium sulphate.
  12. 12. Liquid: Eugenol Parachlorophenol It is a zinc oxide based medicated cement. Mixing is similar to that of procosol (zinc oxide sealer). Setting time is approximately 30-45 minutes. Relatively biocompatible. It also a absorbable sealer. It induces severe inflammatory reaction in 48 hours and gradually reduced after 3 months. Cytotoxicity was observed along with coagulation necrosis which is attributed in the presence of iodoform parachlorophenol. Appetite root canal sealer One of the recently introduced sealers. Powder and Liquid Combination Powder: α-tricalcium phosphate. Hydroxyl apatite Iodoform Bismuth subcarbonate Liquid: Polyacrylic acid.
  13. 13. Distilled water. 3 types – Type I, Type II and Type III 1) Type I : AR used for vital pulpectomy. Type II –30% iodoform used in infected canals that has radiopacity, bactericide and bone invigoration effects. Type III – in between cases which contains a 5% of iodoform. It can be also used in the treatment of accident perforation, as a retrograde filling material. Advantages Disadvantages 1. Biocompatible Sets quickly, hence multiple mix essential. 2. Osteogenic potential Low radiopacity 3. Low tissue toxicity Low wetting ability. Newly Developed Calcium Phosphate type Sealers are: a. Tetracalcium phospate (TeCP) b. Dicalcium Phosphate Dihydrate (DCPD). c. A modified McIIvain’s and Buffer solution (TDM). d. TDM-S-Buffer solution + 2.5% Chondroitin sulphate.
  14. 14. Composition : Powder and liquid systems TDM-S TDM Powder Tetracalcium phosphate Dibasic Calcium phosphate Liquid Citric acid Dibasic sodium phosphate Chondroitin sulphate. Distilled water Tetracalicum phosphate Diabasic calcium phosphate Citric acid Diabasic sodium phosphate Chondroitin sulphate Distilled water Studies have shown excellent biocompatibility. No periapical inflammatory reaction seen. Chondrotin and other ingredients said to promote wound healing. Application of a Root canal sealer RCS may be placed in the canals either by lentulospirals or by Reamers and files. Lentulospiral is made up of fine wire spiraled into the shape of a reverse spiral. It can be used by finger or attached to hand piece. When spiral turned clockwise it carries cement apically. It should not be used in narrow canal for the reason that if binds result in breakage. It tend
  15. 15. to push cement outside the canal when used with handpiece and may set too rapidly as a result of its whipping action. Whatever may be the means of application it should be coated uniformly along the canal walls (Coating the mater cone and accessory cones with sealers is recommended as it reduces the voids and irregularities within the canals.

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