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Endodontic sealers and irrigating solutions /prosthodontic courses

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.

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Endodontic sealers and irrigating solutions /prosthodontic courses

  1. 1. Endodontic Sealers andEndodontic Sealers and Irrigating SolutionsIrrigating Solutions INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY Leader in continuing Dental EducationLeader in continuing Dental Education www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. SealersSealers Functions:Functions: Filler for canal irregularities.Filler for canal irregularities. Assist in microbial controlAssist in microbial control LubricantsLubricants Adheres to dentinAdheres to dentin www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. SealersSealers Characteristics:Characteristics: BiocompatibleBiocompatible -Early toxicity-Early toxicity Resorbable in PAResorbable in PA tissuestissues -Breakdown products-Breakdown products might alter healingmight alter healing RadiopaqueRadiopaque www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. SealersSealers Sealer GroupsSealer Groups ZOEZOE Ca(OH)2Ca(OH)2 G.I.G.I. Resin BasedResin Based Methacrylate basedMethacrylate based www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. SealersSealers Sealer GroupsSealer Groups ZOEZOE - Antimicrobial and cytotoxic due to the- Antimicrobial and cytotoxic due to the resin acids.resin acids. - Free eugenol is irritant and leads to loss- Free eugenol is irritant and leads to loss of volumeof volume www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. SealersSealers Sealer GroupsSealer Groups ZOEZOE Rickert’sRickert’s ProcosolProcosol GrossmanGrossman WachWach TublisealTubliseal N2N2 www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. SealersSealers Sealer GroupsSealer Groups Ca(OH)2Ca(OH)2 -To be therapeutic must be dissociated-To be therapeutic must be dissociated into Ca++ and OH-into Ca++ and OH- -Easily dissolves and desintegrates-Easily dissolves and desintegrates -Poor cohesive strength-Poor cohesive strength www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. SealersSealers Sealer GroupsSealer Groups Ca(OH)2Ca(OH)2 SealapexSealapex CRCSCRCS ApexitApexit www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. SealersSealers Sealer GroupsSealer Groups G.I.G.I. - Cause little tissue irritation- Cause little tissue irritation - Low toxicity- Low toxicity - Adhesive failures- Adhesive failures www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. SealersSealers Sealer GroupsSealer Groups G.I.G.I. Ketac EndoKetac Endo www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. SealersSealers Sealer GroupsSealer Groups Resin BasedResin Based -Also known as Polymers-Also known as Polymers -Good handling characteristics-Good handling characteristics -Good flow and working time-Good flow and working time -Lowest toxicity after 24 hours-Lowest toxicity after 24 hours www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. SealersSealers Sealer GroupsSealer Groups Resin BasedResin Based AH26AH26 AH plusAH plus DiaketDiaket EndofillEndofill www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. SealersSealers Sealer GroupsSealer Groups Methacrylate based sealers:Methacrylate based sealers: - Creates monoblocks with the dentinCreates monoblocks with the dentin - Resilon or EpiphanyResilon or Epiphany -- Soft Resin Endodontic Obturation SystemSoft Resin Endodontic Obturation System - Includes Primer, Sealer and Obturation Material- Includes Primer, Sealer and Obturation Material - Bonded- Bonded www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. SealersSealers Sealer GroupsSealer Groups Methacrylate basedMethacrylate based sealers:sealers: www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. SealersSealers www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. SealersSealers Sealers concernsSealers concerns:: ToxicityToxicity SealSeal www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. SealersSealers Toxicity:Toxicity: Cytotoxicity of resin, zinc oxide andCytotoxicity of resin, zinc oxide and calcium hydroxide based root canalcalcium hydroxide based root canal sealers on Human PDL.sealers on Human PDL. Huang et al Int Endod J. 2002 FebHuang et al Int Endod J. 2002 Feb -- www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Sealers and Irrigating solutionsSealers and Irrigating solutions Toxicity:Toxicity: Huang et al Int Endod J. 2002 Feb:Huang et al Int Endod J. 2002 Feb: -1,2,3 and 7 days-1,2,3 and 7 days - Resin>ZOE>Ca(OH)2- Resin>ZOE>Ca(OH)2 - Byproducts more toxic than Mixed sealer- Byproducts more toxic than Mixed sealer - Sealers dissolve in aqueous environment- Sealers dissolve in aqueous environment - (CaOH)2 sealers more favourable to PA tissues- (CaOH)2 sealers more favourable to PA tissues www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. SealersSealers Apical SealApical Seal The quantitative evaluation of apical sealingThe quantitative evaluation of apical sealing of four endodontic sealersof four endodontic sealers Cobankara et al. J of Endod, 2005 JanCobankara et al. J of Endod, 2005 Jan www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. SealersSealers Apical SealApical Seal Cobankara et al. J of Endod, 2005 JanCobankara et al. J of Endod, 2005 Jan:: - Ca(oH)2, AH 26 and RC sealer.Ca(oH)2, AH 26 and RC sealer. - Computerized fluid filtration at 7-14-21 daysComputerized fluid filtration at 7-14-21 days - Leakage decreased for all sealers from 7-21 daysLeakage decreased for all sealers from 7-21 days - Ca(OH)2 slight better apical seal- Ca(OH)2 slight better apical seal www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. SealersSealers Bond strength and smear layer removalBond strength and smear layer removal Shear bond strength of three resin based sealers to dentinShear bond strength of three resin based sealers to dentin with and without the smear layer.with and without the smear layer. Eldeniz et al. J of Endod 2005 AprilEldeniz et al. J of Endod 2005 April www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. SealersSealers Bond strength and smear layer removalBond strength and smear layer removal Eldeniz et al. J of Endod 2005 AprilEldeniz et al. J of Endod 2005 April - Final canal rinse with 17 % EDTA + NaOCl.Final canal rinse with 17 % EDTA + NaOCl. - Artificial smear layer poured on the dentinal wallsArtificial smear layer poured on the dentinal walls - Diaket, AH plus and Endo-Rez tested.Diaket, AH plus and Endo-Rez tested. - AH Plus showed the highest bond without smear layerAH Plus showed the highest bond without smear layer www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. SealersSealers Microbiologic effect:Microbiologic effect: Survival of E faecalis in infected dentinal tubules after rootSurvival of E faecalis in infected dentinal tubules after root canal filling with different root canal sealers in vitro.canal filling with different root canal sealers in vitro. Saleh, IM; Haapasalo M. Int Endod J 2004 MarSaleh, IM; Haapasalo M. Int Endod J 2004 Mar www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. SealersSealers Microbiologic effect:Microbiologic effect: Saleh, IM; Haapasalo M. Int Endod J 2004 Mar:Saleh, IM; Haapasalo M. Int Endod J 2004 Mar: - Roots infected with E faecalis and exposed 7Roots infected with E faecalis and exposed 7 days to AH plus, Grossman sealer, Ketac endodays to AH plus, Grossman sealer, Ketac endo and Apexit.and Apexit. - AH plus and Grossman sealer were moreAH plus and Grossman sealer were more effective killing E faecaliseffective killing E faecalis www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. SealersSealers Sealer GroupsSealer Groups Methacrylate basedMethacrylate based sealers:sealers: An evaluation of microbial leakage in rootsAn evaluation of microbial leakage in roots filled with Resilon.filled with Resilon. Shipper and Trope J Endod 2004 MayShipper and Trope J Endod 2004 May www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. SealersSealers Sealer GroupsSealer Groups Methacrylate based sealers:Methacrylate based sealers: Shipper and Trope J Endod 2004 May:Shipper and Trope J Endod 2004 May: -- S mutans and E faecalisS mutans and E faecalis - Epiphany and AH 26 used with GP or ResilonEpiphany and AH 26 used with GP or Resilon - Resilon showed minimal leakageResilon showed minimal leakage - GP leaked considerably more with either sealer.GP leaked considerably more with either sealer. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. ConclusionsConclusions Sealers are the most toxic component of RCTSealers are the most toxic component of RCT ZOE has the potential risk of eugenol releaseZOE has the potential risk of eugenol release and loss of volumeand loss of volume Polymer materials have some toxicity duringPolymer materials have some toxicity during polymerization stage but become inert whenpolymerization stage but become inert when polymerizedpolymerized Ca(OH)2 sealers lose integrity compromising theCa(OH)2 sealers lose integrity compromising the seal.seal. AH plus has the lowest long term toxicity.AH plus has the lowest long term toxicity. More research is expected to the promisingMore research is expected to the promising methacrylate based sealersmethacrylate based sealers www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. Irrigating solutionsIrrigating solutions www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. Irrigating solutionsIrrigating solutions Mechanical instrumentation alone:Mechanical instrumentation alone: Bystrom et al.Bystrom et al. Bacteriological evaluation of the efficacy of mechanical RC instrumentation inBacteriological evaluation of the efficacy of mechanical RC instrumentation in endodontic therapy.endodontic therapy. Scand J Dent Res 1981;89Scand J Dent Res 1981;89 ““ Significant reduction of Bacteria counts”Significant reduction of Bacteria counts” Mechanical Instrumentation and different irrigating sol.Mechanical Instrumentation and different irrigating sol. Trope,M et al.Trope,M et al. Reduction of intracanal bacteria using Ni-Ti rotary instrumentation and various medicationsReduction of intracanal bacteria using Ni-Ti rotary instrumentation and various medications.. J EndodJ Endod 2000;262000;26 ““ Bacteria still detected at the fourth session”Bacteria still detected at the fourth session” Irrigating Solutions alone:Irrigating Solutions alone: Attin T et al:Attin T et al: Clinical evaluation of the cleansing properties of the nonClinical evaluation of the cleansing properties of the non instrumental technique (NIT) for cleaning root canals.instrumental technique (NIT) for cleaning root canals. Int Endod J 2002;35Int Endod J 2002;35 ““ Only 21 % of the tested teeth were sufficiently cleaned with NIT tech.”Only 21 % of the tested teeth were sufficiently cleaned with NIT tech.” www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. Irrigating solutionsIrrigating solutions Cleaning and shaping depending on:Cleaning and shaping depending on: 1.1. Rotary InstrumentsRotary Instruments 2.2. Irrigating solutionsIrrigating solutions www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Irrigating solutionsIrrigating solutions Supports and complements theSupports and complements the instrumentation technique.instrumentation technique. Requires appropriate Surface tensionRequires appropriate Surface tension It must have proven cleaning effectivenessIt must have proven cleaning effectiveness Minimal toxicity and yet antibacterial effectMinimal toxicity and yet antibacterial effect www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Irrigating solutionsIrrigating solutions www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Irrigating solutionsIrrigating solutions Must be ALWAYSMust be ALWAYS kept inside the canalkept inside the canal Should NEVER beShould NEVER be delivered underdelivered under pressurepressure www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Irrigating solutionsIrrigating solutions www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Irrigating solutionsIrrigating solutions NaOClNaOCl ChlorhexidineChlorhexidine EDTAEDTA MTADMTAD www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Irrigating solutionsIrrigating solutions NaOCl:NaOCl: Strong proteolytic effectStrong proteolytic effect Tissue dissolving effectTissue dissolving effect Increased TIncreased T° improves antimicrobial effect° improves antimicrobial effect 0.5 to 5.25 %0.5 to 5.25 % Free chlorine consumed during tissue breakdownFree chlorine consumed during tissue breakdown 1 % Sodium Bicarbonate as a dilutent1 % Sodium Bicarbonate as a dilutent Diluted NaOCl limited shelf lifeDiluted NaOCl limited shelf life www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. Irrigating solutionsIrrigating solutions NaOCl IndicationsNaOCl Indications Vital Cases*Vital Cases* Necrotic casesNecrotic cases Requires a minimum contact time withRequires a minimum contact time with dentinal walls.dentinal walls. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Irrigating solutionsIrrigating solutions ChlorhexidineChlorhexidine Binds to HydroxyapatiteBinds to Hydroxyapatite May reduce post-op coronal leakageMay reduce post-op coronal leakage Effect lasts up to 72 hrs.Effect lasts up to 72 hrs. Does not have tissue dissolving propertiesDoes not have tissue dissolving properties www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Irrigating solutionsIrrigating solutions EDTAEDTA Chelating agentChelating agent LubricationLubrication EmulsificationEmulsification Debris cleaningDebris cleaning Viscous suspension (Glycol)Viscous suspension (Glycol) Avoid collagen blockAvoid collagen block With NaOCl kills AnaerobicWith NaOCl kills Anaerobic bacteria by O2 releasebacteria by O2 release www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. Irrigating solutionsIrrigating solutions EDTAEDTA Aqueous solution 17 % removes smearAqueous solution 17 % removes smear layer as a final irrigationlayer as a final irrigation Alters dentinal tubules structureAlters dentinal tubules structure www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Irrigating solutionsIrrigating solutions MTADMTAD Tetracycline + Acid + DetergentTetracycline + Acid + Detergent Used as a final rinse 5 min.Used as a final rinse 5 min. Removes the smear layer without changing theRemoves the smear layer without changing the structure of the dentinal tubulesstructure of the dentinal tubules www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Irrigating solutionsIrrigating solutions MTADMTAD Recommended inRecommended in persistent pulpal/PApersistent pulpal/PA infections.infections. www.indiandentalacademy.comwww.indiandentalacademy.com

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