Root canal sealers /certified fixed orthodontic courses by Indian dental academy


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Root canal sealers /certified fixed orthodontic courses by Indian dental academy

  1. 1. ROOT CANAL SE E AL RS INDIAN DENTAL ACADEMY Leader in Continuing Dental Education
  3. 3. INTRODUCTION Complete obturation of pulp space Sealer performs several functions Purpose of sealing root canals Sealers should act like sutures Variety of sealers have been used
  4. 4. REQUIREMENTS OF AN IDEAL ROOT CANAL SEALERGrossman listed 11 requirements and characteristics1. It should be tacky when mixed2. It should create hermetic seal3. It should be radioopaque – Beyer-olsen andOrstavik (1981)4. The particles of powder should be very fine – Orstavik (1982)
  5. 5. 5. It should not shrink upon setting6. It should not stain tooth structure7. It should be bacteriostatic or atleast notencourage bacterial growth8. It should set slowly9. It should be insoluble in tissue fluids10. It should be tissue tolerant, non-irritating toperiradicular tissue
  6. 6. 11. It should be soluble in a common solvent if it is necessary to remove the root canal filling Following were added to Grossman’s 11 basicrequirements.12. It should neither mutagenic nor carcinogenic13. It should not provoke an immune response inperiradicular tissue
  7. 7. FUNCTIONS OF ROOT CANAL SEALERS 1. Antimicrobial agent 2. Fill the discrepancies 3. Binding agent 4. Lubricant 5. Radioopacity
  8. 8. CLASSIFICATIONSI. According to composition a. Eugenol i. Silver containing ii. Silver free b. Non-eugenol c. Medicated
  9. 9. II. According to Grossman a. Zinc oxide resin cements b. Calcium hydroxide cements c. Paraformaldehyde cements d. PastesIII. According to Cohen (According to the intended use)Type 1 – Materials intended to be used with core material.Type 2 - Intended for use with or without core material.
  10. 10. IV. According to Ingle a. Cements b. Pastes c. Plastic d. Experimental Sealers
  11. 11. INDIVIDUAL SEALERS ZINC OXIDE - EUGENOL CEMENTS Zinc oxide-eugenol cements modified forendodontic use Mixing vehicle mostly eugenol Setting time adjusted for adequate working time Radioopacity 4-5mm of aluminium
  12. 12.  Cements easily lend to addition of chemicals Paraformaldehyde – antimicrobial &mummifying Rosin or Canada Balsam – dentinadhesion Corticosteroids – suppression ofinflammatory reactions. Rosins – 90% resin acid and remaining arevolatile and non-volatile compounds. Resin acids – strong antimicrobial effect Setting of zinc oxide – eugenol cements
  13. 13. KERR ROOT CANAL SEALER OR RICKERT’S FORMULA Dixon & Rickert in 1931 Alternative to gutta –percha based sealers
  14. 14. COMPOSITION PowderLiquidZinc oxide 34 – 41.2% Oil of Cloves 78–80%Precipitated silver 25 – 30% Canada balsam 20-22%Oleo Resins 30 – 16%
  15. 15. Advantages Excellent lubricating Working time more than 30 minute (1:1 ratio) Germicidal action & biocompatibility Greater bulk than any sealerDisadvantage Silver makes the sealer extremely staining
  16. 16. Indication Warm gutta-percha technique – where lateralcanals present.Manipulation Powder in pellet & liquid in dropper bottle 1 drop of liquid to 1 pellet of powder, mixedwith heavy spatula Completely sets & inert within 15 - 30 mins,reducing inflammatory responses.
  17. 17.  Because of rapid setting Grossman’s formula(Procosol-silver cement) appeared in 1936. Both Rickert’s & Grossman’s formula criticizedfor including silver. Grossman’s formula revised in 1958 to exclude silver (Procosol non-staining cement). Grossman’s formula again modified in 1974(Grossman’s Sealer) by addition of sodiumborate to the powder & elimination of allingredients except eugenol from liquid.
  18. 18.  To solve problem of rapid setting of Kerr sealer formula of Kerr sealer EWT (extended working time) developed – 6 hrs working time.
  19. 19. GROSSMAN’S SEALER Modified Grossman’sformula – 1974 Most advocated –provides good seal
  20. 20. COMPOSITION PowderLiquidZinc oxide 40 parts Eugnol 5 partsStabelite resin 30 partsBismuth subcarbonate 15partsSodium Widely anhydroxes 1satisfies borate used & part most of therequirements
  21. 21. Properties Plasticity & slow setting time – sodium borate anhydrate Good sealing potential & small volumetricchange Apical extrusion gets absorbedDisadvantage Resin is of coarse particle sizeSetting Time Hardens approximately 2hrs at 37°C, in canal
  22. 22. Manipulation Sterile glass slab with spatula, 2 or 3 drops of liquid – small increments of cement powder, 2 smooth creamy consistency. To test proper consistency – Drops test & String out test Commercially available as Roth’s 801 andSultan sealer
  23. 23. WACH’S SEALER PowderLiquidZinc oxide 10 grm Canada Balsam 20mlTricalcium phosphate 2grm Oil of cloves 6mlBismuth subnitrage 3.5grmBismuth subiodide 0.3grmHeavy magnesium oxide 0.5grm
  24. 24. Indication All lateral condensation methods, when chanceof overfilling is present.Contraindication When heavy lubrication is neededProperties Medium working time Medium lubricating quality Minimal periapical irritation Sticky (Canada Balsam)
  25. 25.  Should me mixed to smooth creamyconsistency, should string out at least 1 inchwhen spatula raised from glass slab Increasing thickness of sealer lessenslubricating effect, so indicated when there ispossibility of over extension. Available as powder & liquid in separate bottlesAdvantages Germicidal, Less periapical irritation, Stays in position due tackiness
  26. 26. Disadvantages Odour of liquid TUBLI SEAL (1961) Slight modification made in Rickert’s formula 2 paste system – Base & catalyst
  27. 27. COMPOSITION Base LiquidZinc oxide 57 – 59% EugenolOleo resins 18.5 – 21.5% Polymerized resinBismuth trioxide 7.5% AnnidalinThymol iodide 3.75 – 5%Oil & waxes 10 %Setting Time 20 min – Glass slab 5 min – Root Canal
  28. 28. Advantages Easy to mix Extremely lubricated Does not stain Expands after settingDisadvantages Irritant to periapical tissues Very low viscosity – extrusion through apicalforamen Working time less than 30 min & even shorterin presence of moisture
  29. 29. Indications When apical surgery to be performedimmediately after filling Because of great lubricating property – goodchoice when it becomes difficult for a master cone toreach last mm of preparation.Advantages & Disadvantages of ZOE SealersAdvantages Ease of manipulation Adhesion to dentinal walls, only slightdimensional change Radioopaque, germicidal property, minimalstaining, ample working time.
  30. 30. Disadvantages All are cytotoxic & inflammatory response inconnective tissue Note easily absorbed from apical tissues ROOT CANAL SEALERS WITHOUT EUGENOL KLOROPERKA Nyborg & Tullin (1965)
  31. 31. COMPOSITION PowderLiquidCanada Balsam 19.6% ChloroformRosin 11.8%Gutta-percha 19.6%Zinc oxide 49% Powder mixed with liquid chloroform After insertion chloroform evaporates, leavingvoids – shown to be associated with greater leakage www.indiandentalacademy.comthan other materials.
  32. 32. CHLOROPERCHA Mixture of gutta-percha and chloroform Used by some clinicians as sole canal fillingmaterials – techniques is improper.Indications Unusually curved canals In conjunction with well fitted primary cone, can fill accessory canals and root canal space.
  33. 33. HYDRON Wichterle & Lim (1960) Rapid setting hydrophilic plastic material usedas sealer without core Polymer of hydroxy-ethyl-methacrylate Available as injectable root canal filling
  34. 34.  Biocompatible material – confirms to the shapeof the root canal because of plasticity. In contact with moisture, absorbs water andswells Radioopacity very low, less than gutta percha Syringe method makes difficult for the placement accurately & to control formation of voids Once Hydron hardened, removal from the canal could be only by drilling with burs(Peesoreamers)
  35. 35. NOGENOL To overcome irritating quality of eugenol Outgrowth of non-eugenol periodontal pack Advocated as less irritating sealer Expands on setting & improve sealing efficacy Base is zinc oxide with barium sulfate along with vegetable oil. Set is accelerated byhydrogenate rosin, lauric acid, www.indiandentalacademy.comchlorothymol, salicylic acid
  36. 36. POLYCARBOXYLATE CEMENTS Modified zinc oxide powder & aqueous solutionof polyacrylic acid Chelating action, bonding to both enamel &dentin. Because of its adhesive & antibacterialproperties tested as sealer.
  37. 37.  Inflammatory response, when extruded intoperiapical tissues Apical seal inferior to other sealersAdvantages Bonds well to dentine, antibacterial property Fluoride & calcium hydroxide can be addedDisadvantages Special plastic plugger required for insertionsince great adhesiveness to steel instruments
  38. 38. CALCIUM PHOSPHATE CEMENT Browne (1983) showed this cement penetrated on occluded radicular dentinal tubules &enhanced hydroxyapatite formation. Wefel (1984) found it effectively plugged apical foramen & penetrated dentinal tubules upto10mm
  39. 39. RESIN BASED SEALERS DIAKET Polyvinyl resin (polyketone), a reinforcedchelate formed between zinc oxide & Diketone Scheufule (Europe 1952)
  40. 40.  A ketocomplex in which neutral organic agent reacted with basic salts or basic metal oxideforming polyketones Fine pure white powder & viscous honeycoloured liquid, 2 drops of liquid mixed with 1scoop of powder. Hardens rapidly, about 6-8min on glass slab,even more rapidly in root canal Known for its resistance to absorption,superior to other sealers in tensile strength &resistance to permeability Mild inflammatory reaction when over filled.
  41. 41. DIAKET A Chemically similar to Diaket but containsdisinfectant Hexa Chlorophene One of the few medicated cement, does notcontain paraformaldehyde AH - 26 Epoxy resin (Shroeder 1957)
  42. 42.  Epoxy resin based sealers characterized byreactive epoxide ring polymerized by thebreaking of this ringCOMPOSITION Powder LiquidBismuth oxide 60% Bisphenol diglycidyl etherHexamethylene tetramine 25%Silver powder 10%Titanium oxide 5% Formulation recently altered with the removal of silver
  43. 43. Properties Good adhesive property Good flow Antibacterial Contracts slightly while hardening Low toxicity Addition of hardener (Hexamethylenetetramine) makes cured resin chemically &biologically
  44. 44.  Consists of yellow powder & viscous resinliquid mixed to thick creamy consistency. Slow setting, 36-48hrs at body temperature &5-7 days at room temp. Long setting time & material fluidity – nocracking or rapid separation from dentinal walls Parasthesia may occur sometime, recoverywithin 1 - 2 yrs
  45. 45. THERMASEAL Comes in Thermafil kits as their own sealer Formulation similar to AH-26 Widely used in Europe as paste filler to fill the entire canal Good sealing ability & periapical tolerance Can be used with condensationtechniques other than withthermafil
  46. 46. AH PLUS Epoxy resin based sealer, 2 component paste Easy to mix adapt closely to the root canal Minimal shrinkage upon setting, long termdimensional stability
  47. 47. COMPOSITION Paste A Paste BEpoxy resins AdamantaneamineCalcium tungstate N, N-dibenzyl-5-oxononane-Zirconium oxide diamineSilica Calcium tungstateIron oxide pigments Zirconium oxide Silica, Silicone oil Mix equal volume (1:1) of paste A & Paste B Setting time 8 hrs at 37°C
  48. 48.  Spatulas, mixing slabs and instruments,immediately cleaned with alcohol or acetoneAdvantages Excellent biocompatibility Easy handling & application Optimal working time Outstanding physical properties Excellent radioopacity Suitable for all obturation techniques Adverse reaction – reversible acuteinflammation of the oral mucosa, contact with www.indiandentalacademy.comunset paste
  49. 49. FIBREFILL New methacrylate resin – based sealer Used in combination with self curing primer(Fibrefill primers A & B) Composition that of dentin bonding agent
  50. 50. COMPOSITIONRoot Canal Sealant Primer AMixture of UDMA, PEGDMA, Mixture ofAcetone &BIS-GMA Resins dental surfaceactiveBarium borosilicate glasses monomerBarium sulfateSilica Primer BCalcium Hydroxide Mixture of acetone &Calcium phosphate dental methacrylateInitiators resinsStabilizers HEMA www.indiandentalacademy.comPigments Initiator
  51. 51. Manipulation Equal no. of drops of primary A & B placed into mixing well, mixed primer placed in the rootcanal with microbrushes provided by mft., excessremoved with paper points. Main sealer is double syringe, contains base & catalyst. Equal amount of paste mixed & usedas ordinary sealers
  52. 52. CALCIUM HYDROXIDE SEALERS Based on assumption – formation of hardstructures or tissues at the apical foramen. Can induce mineralization, induce apicalclosure inhibit root resorption, inhibit osteoclastactivity Would disintegrate, leaving voids, also havepoor cohesive strength canals) of blood (absent in filledneeded for calcium iron to promote new tissue
  53. 53. SEAL APEX Kerr manufacturing company Non-eugenol calcium hydroxide polymeric resin root canal sealer
  54. 54. COMPOSITIONBase CatalystCalcium hydroxide 25% Barium sulfate 18.6%Zinc oxide 6.5% Titanium dioxide 5.1%Calcium oxide Zinc stearate 1%Butyl benzene Isobutyl salicylateFumed silica (Silicon Dioxide) Disalicylate, Trisalicylate Bismuth trioxide 100% humidity takes 3 weeks to reach final set, never sets in dry atmosphere Sealer expands while setting Healing more advanced with sealapex
  55. 55. CRCS (Calcibiotic root canal sealer) Calcium hydroxide based sealerCOMPOSITIONPowder LiquidZinc oxide EugenolHydrogenated rosin EucalyptolBarium sulfateCalcium hydroxideBismuth subcarbonate
  56. 56.  ZOE eucalyptol sealer to which calciumhydroxide added for osteogenic effect 3 days to set fully in either dry or humidenvironment Shows very little water sorption, quite stable, improves sealant qualities
  57. 57. APEXIT  Available in syringesCOMPOSITIONBase ActivatorCalcium hydroxide 31.9% Trimethylhexanedioldisalicylate 25%Hydrogenized colophony 31.5% Bismuth carbonate 18.2%Highly dispersed silico dioxide 8.1% Bismuth oxide 18.2%Calcium oxide 5.6% Highly dispersed silicone dioxide15%Zinc oxide 5.5% Butane dioldisalicylate 11.4%Tricalcium phosphate 4.1% Hydrogenized colophony 5.4%Polydimethyl siloxane 2.5% Tricalcium phosphate 5%Zinc stearate 2.3% Zinc stearate 5%Paraffin oil Alkylester of phosphoric acidPigments
  58. 58. Advantages Excellent biological tolerance Easy to mix Radioopaque Hard setting VITAPEX Japanese researchers introduced 40% iodoform & silicon oil, iodoform non-bacteriocide released to suppress any bacteria inthe canal or periapex No evidence about sealing or osteogeniccapabilities
  59. 59. MEDICATED SEALERS Usually used without core materials Both endomethazone & N2 containcorticosteroids in addition to paraformaldehyde Contain lead oxide, increases radioopacity Currently N 2 contain neither corticosteroid nor lead oxide but continue to use 5 – 6.5%paraformaldehyde Inclusion of heavy metal ions potentiallydangerous & corticosteroids pose hazards
  60. 60. N2 Sergenti & Ritcher (1961) N 2 refers to second nerve (pulp is referred first nerve) Two different types were available a. N 2 normal – root filling b. N 2 apical – medication of canal Recently N 2 universal – features of both N 2normal & apical
  61. 61. COMPOSITION (N 2 universal)Powder LiquidZinc oxide 68.51g EugenolLead tetroxide para 12g Oleum RosaeParaformaldehyde 4.7g OleumlavandulaeBismuth subcarbonate 3.7gBismuth subnitrate 3.7gTitanium dioxide 8.4gPhenyl mercuric borate 0.09g Corticosteroids now added separately Introducing formaldehyde in the root filling toobtain a continuous release of gas, resulting inprolonged fixation & antiseptic action Toxicity – irritation is severe when forced into maxillary sinus or mandibular canal – persisting parasthesia
  62. 62. ENDOMETHASONE Similar to N 2 compositionPowder (pink in color) LiquidZinc oxide 100g EugenolBismuth subnitrate 100gDexamethasone 0.019gHydrocortisone 1.6gThymoliodide 25gParaformaldehyde 2.2g
  63. 63.  Sometimes endomethazone gives pain ordiscomfort after 6-8 weeks of insertion SPAD Advertised as one-visit non-irritant radioopaque sealer Resorcinol formaldehyde resin supplied aspowder and 2 liquids
  64. 64. Powder Liquid L (Clear)Zinc oxide 72g Formaldehyde solution 87gBarium sulfate 13g Glycerin 13gTitanium dioxide 6.3g Liquid LD (Red)Paraformaldehyde 4.7g Glycerin 55gHydrocortizone acetate 2.0g Resorcinol 25gCalcium hydroxide phenyl 0.94g HCL 20gMercuric borate 0.16gEqual parts of two liquids mixed with powder.
  65. 65.  Essential reaction to form resin is betweenresorcinol & formaldehyde Setting time 24hrs Small quantities of sealer introduced intoperiapical areas deliberatelyIndications Acute endodontic infection & teeth withperiapical lesion
  66. 66. BIOCALEX Bernard (1952) – OcalexPowder LiquidCalcium oxide GlycolZinc oxide Water Expands more than 6 times its original volume Calcium oxide & water react within the tooth toform calcium hydroxide Efficacy of sealing is controversy
  67. 67. IODOFORM PASTE Walkhoff (1928) Alone or in combination with other substances used as sealer with core materials Resorbable paste Iodoform 60 parts, 40 parts of solutioncontaining 45% parachlorophenol, 49% camphor &6% menthol Commercial preparation – Kri-1 paste Stimulates periapical tissue & accelerate bone formation
  68. 68. Disadvantages Periapical irritation Discoloration Rise in blood level of iodine DENTALIS ZOE type sealer contains not only iodoform but calcium hydroxide as well Distributed in North America by DiaDent Sets rapidly (5-7mm) and is very tacky
  69. 69. GLASS IONOMER SEALER (KETAC – ENDO) Less tissue irritation, low toxicity Little biological data available as sealer Because of adhesive qualities, recommendedas sealers
  70. 70. Powder LiquidCalcium aluminium lanthanum- Glycol Fluorosilicate glass Polyethelene-polycarbonic acid/Calcium volframate maleic acidCilicic acid CopolymerPigments Tartaric acid WaterAdvantages Best physical qualities, best bonding to dentin, fewest voids, best flow, strengthen the rootsDisadvantages Cannot be removed from the root canal Toronto / osract group reported ketacendo can be effectively removed
  71. 71. SILICONE BASED ROOT CANAL SEALERS Silicone is inert and biocompatible, widely usedin medicine as implant material. Silicon basedsealers are now available ENDO FILL Injectable silicone resin endodontic sealant –Lee Endo-fill Can be used in conjunction with core materialor as a sole sealant Consists essentially of silicone monomer and silicone based catalyst plus bismuth subnitrate
  72. 72.  Low working viscosity with good adaptation to tooth structure & good penetration of accessory canals Cures to pale pink rubbery solid resemblinggutta-percha Setting time can be controlled from 8-90min by varying the amount of catalyst. Moist cotton pellet used to compact fillingvertically Set material be removed with Gates-glidden,Peeso-reamers & endodontic files.
  73. 73. Advantages Ease of preparation, adjustable working time,low working viscosity, rubbery consistency, non-resorbable materialDisadvantages Canal must be absolutely dry, shrinks uponsetting, bonding ability decreases not used within20minute of mixing
  74. 74. ROEKOSEAL Composition – polydimethyl siloxane, siliconeoil, paraffin base oil, hexachloroplatinic acid,zirconium dioxide
  75. 75. Properties Excellent flow Insolubility Dimensional stability – expands slightly (0.2%) Extremely biocompatible, does not containeugenol Highly radioopaque
  76. 76. NEWER SEALERS A new material, Resilon (Epipheny, Dentron clinical technologies,Sybron Endo) Two offering solutions to endodontics greatest filling problems Resilon core shrinks only 0.5% when heated,physically bond to sealer by polymerization, nogaps are present due to shrinkage.
  77. 77. System comprised of Primer (Self etch primer) - sulfonic acid,HEMA, water & polymerization initiator Resilon sealer (Dual-curable, resin-basedcomposite sealer) – BISGMA, ethyoxylatedBISGMA, UDMA, Hydrophilic difunctionalmethacrylates. Fillers – calcium hydroxide bariumsulfate, barium glass, bismuth oxychloride &silica Resilon core material (Thermoplastic synthetic polymer based root canal core).Bioactive glass, bismuth oxychlorideand barium sulfate.
  78. 78.  Biocompatible, non-cytotoxic & non-mutagenic Monoblock conceptMETHOD OF OBTURATION WITH RESILON /EPIPHANY SYSTEM Smear layer removal – 17% EDTA or 2%chlorhexidine, canal should be 100% dry Placement of the primer Placement of the sealer
  79. 79.  Obturation Curing Coronal restoration SEALER PLACEMENT EFFICIENCY OF ROOT CANALSEALERS
  80. 80. CONCLUSION With the increased amount of root canaltreatment being performed by both the generalist &specialist, there have been renewed efforts todevelop better sealer and core obturation materials &techniques. To date none of the materials &techniques have safely reached the highest biologicand technical level. It would seem that the dental profession hasnot yet decided upon a universal root canal fillingmaterial.
  81. 81. REFERENCES1. Bernath M & Szabo J. Tissue reaction initiated bydifferent sealers, International Endodoontics Journal. 2003;36 : 256 – 261.2. Branstetter J, Von Fraunhofer JA. The physicalproperties & sealing action of endodontic sealercements : A review of the literature. Journal of Endodontics. July 1982; 8 (7) : 312 – 316.2. Christos Gogos et al. Adhesion of a NewMethacrylate Resin – Based Sealer to Human Dentin. Journal of Endodontics, Apr. 2004; 30 (4) : 238 – 240.3. Caicedo R. et al. The properties of Endodontics sealer cements. Journal of Endodontics, 1988;14(11):527–534.4. De Moore RJG et al. The long-term sealing ability of an epoxy resin root canal sealer used with five gutta-percha obturation techniques. Int. Endo. J. 2002; 35:275-282.
  82. 82. 5. Fabricio B et al. Fracture resistance of rootsendodontically treated with a new resin filling material.JADA. May 2004, Vol.135: 646-651.6. Franklin S. Weine. Endodontic therapy. 5 th Edition.Mosby – Year Book Inc., 467 – 476.7. Funda Kont et al. In vitro antibacterial activities of root canal sealers by using two different methods. J. Endod.Jan 2004, 30(1) : 57 – 60.8. Guy Shipper et al. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer –based root canal filling material (Resilon). J. Endod. May 2004, 30(5): 342-347.9. Jacob G. Daniel. Advanced endodontics for clinicians. 119 - 121
  83. 83. 10. Jean Camps & Imad About. Cytotoxicity testing ofEndodontics sealers. J. Endod. 2003, 29(9) : 583-586.11. John I. Ingle, Leif K. Bakland. Endodontics. Fifth edition. 579-596.12. Louis I Grossman. Endodontic Practice. 11 th Edition, 253-259.13. Stephen Cohen, Richard C. Burns. Pathways of the pulp.2 nd Edition, Mosby 362-372.14. Stephen Cohen, Richard C. Burns. Pathways of the pulp.4 th Edition, Mosby 257-260.15. Stephen Cohen, Richard C. Burns. Pathways of the pulp.8 th Edition, Mosby 550 – 556.
  84. 84. Thank you for