2. Experience, continued training
and our imagination is the source
of success
and the only way we can achieve
individual quality and true
esthetics..
Douglas A.Terry
3.
4. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Bioceramics in endodontics are the materials that are composed of
tricalcium silicate–based cement synthesized from lab-grade chemicals..
The goal of introducing:-
The primary goal …. elimination of the Portland cement due to
presence of trace elements such as chromium,
arsenic and lead.
S. Drukteinis, J. Camilleri (eds.),
Bioceramic Materials in Clinical Endodontics,
Classification :-
water-based , powder and liquid ( Type 4 ).
premixed where the powders are suspended
in an alternative vehicle, and these materials set
when in contact with the moist dental tissues( Type 5).
5. ISO Standards ISO-norm 6876:2012
Film thickness should be less than 50micro mm
Flow rate should be greater than 17mm
Solubility not be more than 3% by volume
Radio-opacity should be greater than 3mm aluminum
Hydraulic Endodontic Materials
Dr.Abdalazim Badraldin
Sudanese dental center
6. Hydraulic Endodontic Materials
Properties
Hydrophilic material …. Need water … hydration reactions --- Calcium silicate
hydrate gel + release of calcium ions
Calcium ions react with calcium phosphate to form hydroxyapatite
with blood form calcium carbonate
….active bio- materials.
Alkalinity….released of calcium ions …increase pH more than. 12
….antimicrobial activities .
Dimensional Stability …insoluble..create hard seal.
No shrinkage on setting…slight expansion about 0.002% of volume.
Dr.Abdalazim Badraldin
Sudanese dental center
8. Hydraulic Endodontic Materials
Properties
Dr.Abdalazim Badraldin
Sudanese dental center
Working time & setting time.
The working time closed to 30mins…. The setting time between 2.5 to 5 hours
depend on the moisture present ,,,extended to 10 hours if the
is canal completely dry.
Radio-opacity
Good …premixed are more radio-opaque than the mixable type
Retreatability
difficult…this is why gutta percha cones are used.
9. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Clinical Classification of Hydraulic Endodontic Materials
- Intracoronal
pulp protection, barrier for
regenerative endodontic
procedures
- Intraradicular
root canal sealing, apical plugs
- Extraradicular
root-end fillers, perforation
repair materials.
According to their Clinical use
10. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-coronal Tricalcium Silicate – based Cement
Pulp Preservation
- Direct & Indirect Pulp Capping
- Pulpotomy
Apexogenesis
Pulp Regenerative Procedures
Type 4 tricalcium silicate cements are more suitable
than type 5 cements for coronal use due to :-
1-limited amount of fluids available in pulp
protection procedure
2- Long setting time of type 5 ( complicate the clinical technique).
11. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-coronal Tricalcium Silicate – based Cement
The most important feature necessary for the coronal use of
hydraulic calcium silicate–based cements is the calcium ion release,
Calcium ions
antimicrobial characteristics
barrier formation of reactionary
and reparative dentine.
challenge with using hydraulic calcium silicate materials coronally
12. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-coronal Tricalcium Silicate – based Cement
challenge with using hydraulic calcium silicate materials coronally
The challenges with using composite filling ;
The Etching time must be reduced because the etching process
the microstructures of the hydraulic cement.
The Bond strengths to hydraulic cement have been shown to be
weak and not durable.
13. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-coronal Tricalcium Silicate – based Cement
The use of hydraulic cements reverse irreversible pulpitis when used
as a dressing over partial or full pulpotomies in permanent teeth.
14. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-radicular Tricalcium Silicate – based sealers
The intra-radicular use of the hydraulic calcium
silicate–based materials includes the use as sealers
particularly using the single-cone obturation
technique and also as an apical plug for immature
teeth with an open apex.
The materials used can be both water-based and premixed.
The hydraulic calcium silicate–based sealer chemistry
is quite similar for most brands
15. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-radicular Tricalcium Silicate – based sealers
Water-based set fully in dry canal.
premixed root canal sealers need wet canal to set ,
so it is recommended not to dry the root canal
completely prior to obturation.
Hydraulic sealers are biocompatible , bioactive materials
and showed a high degree of cell proliferation .
The cytotoxicity of hydraulic sealers ,was dose-dependent so
excessive overfilling is not recommended.
16. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Intra-radicular Tricalcium Silicate – based sealers
The sodium hypochlorite potentiates the antimicrobial effect of the
hydraulic sealers.
The use of Ethylenediaminetetraacetic acid (EDTA) as a final irrigant is
not recommended because:-
hydraulic sealers mineral interaction with dentin will affected due to:-
removal of mineral and expose of collagen.
the push-out bond strength of hydraulic sealers was reduced
Sodium hypochlorite followed by normal saline or distilled water was
recommended as a final irrigant .
The premixed sealers are less susceptible to changes in temperature,
during hot vertical compaction obturation technique since they
have an alternative vehicle.
17. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Extra-radicular Tricalcium Silicate – based sealers
The extra-radicular use of hydraulic materials includes
root-end surgery
surgical repair of root perforations
The material used for apical surgery need to be:-
radiopaque to enable detection on patient recall,
exhibit low solubility
easy to handle.
Material strength and setting time are less important
Different formulations of
EndoSequence® BC RRM™
(upper row) and TotalFill® BC
RRM™ (lower row) root
repair materials: paste (a),
putty (b), and fast set putty (c)
a b c
18. Dr.Abdalazim Badraldin
Sudanese dental center
Extra-radicular Tricalcium Silicate – based Cement
In regenerative & surgical endodontic procedures the hydraulic
cements interact with blood to form the calcium carbonate.
Calcium Carbonate are potential materials to promote bone and regeneration
for bone tissue engineering applications.
Clinical applications of bioceramic materials in endodontics
Drs. Marga Ree and Richard Schwartz
19. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
The difference between bioceramic sealers obturation techniques
and
traditional obturation techniques
Sealer-based technique
More Sealer less Gutta Percha
Traditional technique
More Gutta Percha less Sealer
21. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Basic technique
Confirm the master cone length and fitness
Coat master GP with sealer
Carry it to the canal & coat the canal wall
Shear the GP & condense
Advantages:-
simple technique.
No wastage of material.
Useful in case of narrow canals
can be done without magnification.
23. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Injection Technique
o inject sealer into canal in coronal & middle 3rd
o Then insert GP & carry it to apical 3rd of canal
o Avoid overfills and void formation…magnification is preferable.
24. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Hybrid Technique
o inject sealer into canal in coronal & middle 3rd
o Then insert a coated GP with sealer & carry it to apical 3rd of canal
o Avoid overfills and void formation…magnification is preferable
o Ideal for wider canals
25. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Warm Hydraulic condensation
water-based hydraulic calcium silicate–based sealers, are sensitive to the heat
and should be used with cold obturation techniques , not compatible for warm
condensation techniques, following manufacturer’ instructions is recommended.
all premixed materials can be used with all cold and thermoplastic obturation
techniques at the higher temperatures can be used with no restrictions.
26. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Hot modified Hydraulic condensation
The heat carrier temperature at 130-150 ℃ instead of 200-250 ℃
Heat carrier insertion 8-10 mm instead of 4-5mm
short of working length.
Reach penetration depth in 3 secs, rather than 5 secs,
with slight increase the pressure to ensure the sealer
penetrates throughout the canal’ complex spaces
Roots 2018
27. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Hot modified Hydraulic condensation
Conclusions
Preheating of the sealer used in conjunction with single cone obturation
technique could be developed further with the use of appropriate
sealers for this specific technique.The application of heat
modifies the sealer properties and this could be used to enhance the
quality of the obturation.
28. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
Conclusion
EndoSequence, HiFlow, and AH Plus appear to be suitable sealers
to use with high temperatures. Heat application causes minor
changes in their setting and chemical properties; they maintain
stability with minimal weight loss.
BioRoot RCS, on the other hand, shows a significant amount of
weight loss, increased in viscosity, and reduced flowability
after heat application
29. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
Conclusions
Thermal treatment did not lead to any substantial chemical changes
30. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
The difference between bioceramic sealers obturation techniques
and
traditional obturation techniques
JOE Volume -, Number -, - 2021 Sealer-Based Obturation 1
CONCLUSION
Within the limitations of this study, it was found that SBO using Endoseal
TCS can be a possible alternative to CWC using AH Plus.
Sealer extrusion and postoperative pain negatively affect outcome
of root canal treatment.
31. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Hydraulic Condensation Obturation
Techniques
Large void following root canal
obturation with single cone technique.
Calcium Silicate-Based Root Canal Sealers: A
Narrative Review and Clinical Perspectives
Germain Sfeir et al ….. Materials 2021, 14, 3965
void incidence should be always put in perspective with the
root canal anatomy(oval canal) and the obturation
technique used.
Voids
32. Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
SANTOS-JUNIOR et al
Braz. Oral Res. 2021;35:e028
Conclusion :-
None of the techniques used with the new calcium silicate-based Bio-C Sealer
were associated with void-free fillings in flattened root canals.
The thermoplastic technique had a significantly lower percentage of voids than
the single-cone technique in the cervical/middle thirds. Both techniques were
similar in the apical third
Voids
33. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
Conclusions
The present study demonstrated that the voids between the filling materials and the
root canal walls were not significantly different between the two obturation techniques
in the apical area. Therefore, the SC technique and CW technique were not different
with regard to void formation in the apical area.
single-cone (SC) technique, the continuous wave (CW) technique
Voids
34. Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
Gutta-percha cone-mediated ultrasonic activation to
avoid void formation in large or oval canals
Kim et al. JOE — Volume -, Number -, - 2017
During the application of calcium silicate cement
to the root canal, vibration produce a series of rapid
compressive impulses that reduce the surface friction
between the cement particles and remove the
entrapped air bubbles in the sealer
The ultrasonic waves generated from the device should
pass through 3 media, including the ultrasonic tip,
the tweezer, and the GP cone. Therefore, the actual
Ultrasonic vibration transmitted to the GP cone
was reduced without affecting the integrity of the sealer.
Voids
35. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
gutta-percha cone-mediated ultrasonic activation
Kim et al. JOE —Volume -, Number -, - 2017
Voids
36. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
Materials 2020, 13, 4389; doi:10.3390/ma13194389
The removal of remnants that blocked the orifice of the accessory canal
by irrigation was much more important than the force applied by
the filling instruments, such as pluggers.
Conclusion
The SC technique has the potential to be used as a useful
method for root canal filling if it is adequately applied.
37. Bioceramic – Sealers Obturation Techniques
Dr.Abdalazim Badraldin
Sudanese dental center
Obturation Techniques
Conclusion
Tubular penetration was higher in the premixed endodontic bioceramic
sealers than powder and liquid types
Dentinal Tubules penetration