Endodontic Sealers

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  • RTD / Bisco have introduced improvements as they developed the technology to improve working qualities WITHOUT compromising their ideal, proven mechanical properties.
  • Endodontic Sealers

    1. 1. Endodontic Sealers- Their Properties and Effects on Fiber Post Retention www.hi-dentfinishingschool.blogspot.com
    2. 2. To obtain fiber post retention with 2 endodontic sealers and 2 cements Purpose
    3. 3. 1 st part of the study- Post Indications <ul><li>The primary purpose of post is to retain the core build up material or to reinforce the remaining tooth structure to provide retention for the final restoration. </li></ul><ul><li>Rosenstiel of fixed prosthodontics.9 th Ed. </li></ul>
    4. 4. <ul><li>William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc. </li></ul>Post Classification Custom Prefabricated Can be cast from: -Direct pattern in pt mouth - In direct pattern in laboratory <ul><li>Noble alloy </li></ul><ul><li>Carbon fiber posts </li></ul><ul><li>Composite fiber posts </li></ul><ul><li>Ceramic (zirconia) posts </li></ul><ul><ul><li>ceramic composite </li></ul></ul>
    5. 5. Evolution of the Fiber Post 1995: C-POST 1997: AESTHETI-POST 1998: U.M. AESTHETI-PLUS 1999: AESTHETI-PLUS 1999: LIGHT-POST 2001 D. T. (double-taper) LIGHT-POST ®
    6. 6. Advantages of Composite Fiber Post <ul><li>Can bonded to the tooth with resin cement </li></ul><ul><li>Modulus of elasticity similar to dentin </li></ul><ul><li>Ease of removal for retreatment </li></ul><ul><li>Excellent esthetics </li></ul><ul><li>Non corrosive </li></ul><ul><li>Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod </li></ul>
    7. 7. <ul><li>Fiber posts absorb stress as a result have different root fracture location </li></ul><ul><li>Twin luscent. Light transmitting esthetic posts for endodontically treated teeth </li></ul><ul><li>Fracture with metal posts </li></ul><ul><li>Fractured root </li></ul><ul><li>Vector of Force </li></ul><ul><li>Fractured root </li></ul><ul><li>Vector of Force </li></ul><ul><li>Fracture location with fiber posts </li></ul>
    8. 8. Disadvantages <ul><li>Their retention is based on the bond strength – technique sensitive. </li></ul><ul><li>Many fiber posts are not radiopaque </li></ul><ul><li>Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod </li></ul>
    9. 9. Types of luting cement <ul><li>Etch-and-rinse adhesive </li></ul><ul><li>Self-etch adhesive </li></ul><ul><li>Self-adhesive </li></ul><ul><li>Glass-ionomer adhesive </li></ul>
    10. 10. Factors affecting post retention <ul><li>Post length </li></ul><ul><li>- Increased Length = More Retention </li></ul><ul><li>-Longer Length = More Perforation </li></ul>
    11. 11. <ul><li>Post diameter </li></ul><ul><li>Post design </li></ul><ul><li>Luting cement </li></ul><ul><li>Canal shape </li></ul><ul><li>William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc </li></ul>
    12. 12. Literature reviews- post retention (push out tests) <ul><li>Francesca Z et al.(2008), 50 extracted teeth Panavia F, Clearfil, Variolink II, Rely X Unicem, Experimental GC . No significant difference among coronal, middle, apical sections for post retention or seal . Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher than the others </li></ul><ul><li>Vivian JJW. Ya-ming C et al.(2008), measured post retention for two fiber reinforced post types ( carbon fiber post – quartz fiber reinforced posts) cemented with (total etch resin cement /C&B and a self-adhesive resin cement Rely X Unicem ), The total etch adhesive had significantly better post retention the self adhesive cement. BS  coronal-> apical </li></ul><ul><li>Ayse D et al.(2007), Compared retention produced by a total etch resin cement (Variolink II) and a self adhesive cement (Unicem) for 4 reinforced posts using a push-out test. Fiber composite posts with Variolink II had the greatest bond strength. </li></ul>
    13. 13. 2 nd part- Microleakage <ul><li>Passage of fluid and bacteria between the sealer and the dentin. </li></ul><ul><li>Coronal leakage </li></ul><ul><li>Apical leakage </li></ul><ul><li>AM Yung. Direct Aesthetic Dental Restoratives: Microleakage and adhesion </li></ul>
    14. 14. <ul><li>Coronal microleakage leads to : </li></ul><ul><li>Discoloration </li></ul><ul><li>Recurrent caries </li></ul><ul><li>Apical microleakage leads to: </li></ul><ul><li>Apical infection </li></ul><ul><li>AM Yung. Direct Aesthetic Dental Restoratives: Microleakage and adhesion </li></ul>Microleakage (cont’d)
    15. 15. Causes of Microleakage <ul><li>Polymerization shrinkage of the sealer </li></ul><ul><li>Sealer porosity </li></ul><ul><li>Poor adhesion of the sealer </li></ul><ul><li>AM Yung. Direct Aesthetic Dental Restoratives: Microleakage and adhesion </li></ul>
    16. 16. Types of Sealers <ul><li>Eugenol based sealers: </li></ul><ul><ul><li>Zinc – oxide eugenol </li></ul></ul><ul><li>Non- Eugenol based sealers: </li></ul><ul><ul><li>Calcium – hydroxide cement </li></ul></ul><ul><ul><li>Resin based cement </li></ul></ul><ul><ul><li>Glass ionomer cements </li></ul></ul><ul><li>Ingle J.Endodontics.4 th Ed </li></ul>
    17. 17. <ul><li>Good adhesion to root dentin </li></ul><ul><li>Produce a hermitic seal </li></ul><ul><li>Radiopaque </li></ul><ul><li>Have low shrinkage </li></ul><ul><li>Slow set </li></ul><ul><li>Bacteriostatic </li></ul><ul><li>Insoluble in tissue fluid </li></ul><ul><li>Non-irritating </li></ul><ul><li>Soluble in common solvent </li></ul><ul><li>Non staining </li></ul><ul><li>Ingle J.Endodontics.4 th Ed . </li></ul>Ideal root canal sealers
    18. 18. Microleakage measured <ul><li>Dye penetration </li></ul><ul><li>*Dyes used: </li></ul><ul><li>-India Ink </li></ul><ul><li>-Methylene Blue </li></ul><ul><li>-Silver Nitrate </li></ul><ul><li>Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal </li></ul><ul><li>adaptation.2005 </li></ul>
    19. 19. Dye penetration <ul><li>Factors affecting dye penetration techniques: </li></ul><ul><li>Air bubbles in the canal </li></ul><ul><li>pH of the dye </li></ul><ul><li>Molecular weight of the dye </li></ul><ul><li>Immediate immersion / delayed immersion in the dye </li></ul><ul><li>Tooth anatomy </li></ul><ul><li>Skill of the operator </li></ul><ul><li>Type of sealer </li></ul><ul><li>A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown by four different dyes with two evaluating methods.1998 </li></ul>
    20. 20. <ul><li>- Streptococcus mutans mostly used </li></ul><ul><li>- Viability of the freshly inoculated bacteria is required </li></ul><ul><li>Francesca M. efficacy of two contemporary single- cone filling techniques in preventing bacterial leakage.2006 </li></ul>Bacterial filtration
    21. 21. Fluid Filtration Technique Hasan O, et al. Apical Leakage of Resin Based Root Canal Sealers with a New Computerized Fluid Filtration Meter JOE 2005
    22. 22. Microleakage Literature Review <ul><li>F.Kont Cobenkara et al. (2002) Measured microleakage of endodontic fillings using 4 root canal sealers (AH Plus, Roeko seal, Ketac-Endo, Sultan) by a fluid filtration method, Roeko Seal and AH Plus had better seal than Ketac-Endo or Sultan. </li></ul><ul><li>Fernando G et al.(1995), compared the sealing ability of Ketac-Endo and Tubli Seal. Teeth using India ink 7 day immersion and cleared. Stain measured at X50. No significant difference between groups. </li></ul>
    23. 23. 3 rd Part -Effects of Eugenol on Post Retention <ul><li>Most sealers contain zinc oxide eugenol (ZOE) </li></ul><ul><li>Adversely affects composite resins… </li></ul><ul><li>Reduced transverse or bending strength (Reisbick 1971) </li></ul><ul><li>Decreased surface hardness (Rosenstiel & Gegauff 1988) </li></ul><ul><li>Interfere with dentinal bonding of resins (Hansen& Asmussen 1987) </li></ul>
    24. 24. Literature Review <ul><li>No significant difference in post retention in teeth containing eugenol and non-eugenol root canal sealers. S.T Davis et al.(2007) </li></ul><ul><li>The group filled with GP and ZOE sealer had lower bond strength than the one without sealer . Edson A et al.(2006) </li></ul><ul><li>No significant influence on the mean retention of endodontic post luted with composite resin cement .Teeth were obturated with GP and different root canal sealers (ZOE, AH 26,CaOH). Hagge et al.(2002), </li></ul><ul><li>No difference in post retention with ZOE or CAOH when prefabricated posts luted with resin cement. David R B et al.(2000) </li></ul>
    25. 25. Specific Aims <ul><li>In endodontically treated teeth </li></ul><ul><li>To measure and compare the leakage of glass ionomer and zinc oxide eugenol sealers. </li></ul><ul><li>To evaluate the retention of 40 fiber post using 2 cements-a self-etching and a self- adhesive. </li></ul>
    26. 26. Hypotheses <ul><li>There will be no significant difference in leakage when using glass ionomer (Activ-GP) or zinc oxide eugenol (Roth’s) </li></ul><ul><li>There will be no significant difference in post retention when the posts are cemented with a self-adhesive (Rely X Unicem) or dual-cure (Panavia F 2.0) cement. </li></ul><ul><li>There will be no effect on post retention of either cement by the zinc oxide eugenol or glass ionomer sealers </li></ul>
    27. 27. Study Design 40 mandibular premolars 10 teeth +ZOE+ fiber post+ Rely X Unicem 10 teeth+ ZOE + fiber post+ Panavia F 2.0 10 teeth + GICs+ fiber post +Rely X Unicem 10 teeth+ GICs+ fiber post +Panavia F2.0
    28. 28. Gutta-percha Paper point Sealers Files Finger spreader Materials
    29. 29. Fiber Post -3M ESPE RelyX Unicem Panavia F 2.0 Materials (con’t)
    30. 30. <ul><li>Extracted single canal premolars were selected and calculus and soft tissues removed </li></ul><ul><li>Two radiographs made- 1 from mesiodistally & 1 from buccolingual </li></ul><ul><li>Each tooth was sectioned with diamond disc under water spray 1mm coronal to CEJ </li></ul>Methods
    31. 31. <ul><li>Specimens were instrumented to # 45 file </li></ul><ul><li>and filled with GP using lateral condensation </li></ul><ul><li>Sodium hypochlorite solution (5%) was </li></ul><ul><li>used to irrigate canal throughout instrumentation </li></ul><ul><li>The canals were dried with paper points </li></ul><ul><li>and obturated with MC 45, sealer using </li></ul><ul><li>finger spreader and lateral condensation method </li></ul><ul><li>Coronal orifice was sealed and stored in </li></ul><ul><li>incubator at 37° C for 7 days before proceeding </li></ul>Methods (cont’d)
    32. 32. F. Zicari.E.Couthino. Jan DM. Bonding and sealing ability of fiber post bonding.2008 Post Preparation
    33. 33. Control length with Peeso Reamer Post space prepared With Drill Injecting self etching primer Injecting self etching primer
    34. 34. Injecting mixed Panavia F2 Post placement Light curing 20 sec
    35. 35. Self- adhesive System Mixing Unicem Coating post with Unicem Unicem cemented post Cured for 20 sec
    36. 36. Universal Testing Machine (Instron) Push-out Test
    37. 37. Microleakage <ul><li>Apical sections were coated with two layers of nail polish leaving the apical 1 mm exposed </li></ul><ul><li>The teeth immersed into a 50% wt silver nitrate dye for one hour then washed by distilled water for 1 minute </li></ul><ul><li>Inserted in photo developing solution and exposed them to light for 12 h </li></ul><ul><li>Washed with running water and the nail polish cleaned </li></ul><ul><li>All specimens were cleared using the 5%nitric acid, followed by washing for 2 h and dehydrated in ascending concentration of alcohol (80%, 90%, and 100%) </li></ul><ul><li>The roots were subsequently cleared using methyl salicylate </li></ul><ul><li>The cleared specimen examined under a 3D microscope (100X) </li></ul>Suspended apical section Suspended apical section Coated with nail polish
    38. 38. Keyence Microscope (3D) Measuring dye penetration Cleared specimens
    39. 39. Gutta -percha <ul><li>Dye </li></ul>
    40. 40. SEM Evaluation
    41. 41. Results
    42. 42. The Three Way Analysis (ANOVA) of Post Bond Strength 0.4884 11.529 Sealer*Cement 0.0752 76.986 Cement 0.8318 1.080 Sealer 0.06012 12.192 Third Section P-value Mean Square Source
    43. 43. Bond Strength (MPa) -Mean and Std of four group 12 ±2.5 Rely X Unicem Zinc Oxide Eugenol 8 ±1.2 Panavia F 2.0 Zinc Oxide Eugenol 10.3 ± 1.3 Rely X Unicem Glass Ionomer 7.7 ± 2.6 Panavia F 2.0 Glass Ionomer Mean ±SD Cement Sealer
    44. 44. Interaction between Post Retention, Sealer Type and Cement
    45. 45. Failure Mechanism Resin cement adhered to the post surface. 100X SEM Evaluation
    46. 46. Rely X unicem- Dentin <ul><li>short resin tags were present </li></ul>
    47. 47. PanaviaF2- Root Canal Dentin
    48. 48. SEM Evaluation- canal dentin <ul><li>Rough surface shows the smear layer was not removed and part of the post matrix was present. (tooth surface) </li></ul>Dentin
    49. 49. Mean ±SD for Microleakage (mm) 2.1 ± 0.4 1.5 ± 0.3 Mean ±SD Zinc Oxide Eugenol Glass Ionomer Sealer
    50. 50. Mean ±SD for Microleakage
    51. 51. Discussion
    52. 52. <ul><li>Results were higher for both cements compared to Goracci et al who used a “thin slice’’ push- out test and transmission electron microscopy. The tested adhesive cements were VariolinkII (10 ±3 MPa) Rely X Unicem(5.05± 3) Panavia (5.04±3) </li></ul>
    53. 53. <ul><li>This study showed no difference in bond strength between the coronal, middle, apical third with both cements in contrast to Carlos 2007 thesis. </li></ul><ul><li>This study agrees with Zicari F et al, who reported not significantly difference among the coronal. middle and apical sections for each luting cements </li></ul><ul><li>BS was measured for Panavia 21(12.6 ±3) Unicem(11± 4) VariolinkII(11±4 ) </li></ul><ul><li>A 20 gauge Endo-Eze tip that reached the apical root canal area ensured the delivery of the conditioner to the deepest part portion of the canal </li></ul>
    54. 54. <ul><li>The type of sealer used has no effect on values of bond strength which agrees with S.T Davis et al, </li></ul><ul><li>no significant difference with non eugenol (190 ±55) and eugenol (183± 56) </li></ul><ul><li>Teeth were irrigated with water for cleaning purpose before cementation. No sodium hypochlorite were used. Which might effect retention. A study by Hale A et al.(2003) showed that 5% NaOCL reduce the bond strength to dentin of Panavia F,C&B Metabond, ViriolinkII </li></ul>
    55. 55. <ul><li>Dye penetration technique was subjective </li></ul><ul><li>Sealing the root canal coronal and apical parts of the root canal is equally important for the success of treatment </li></ul>
    56. 56. Conclusion
    57. 57. <ul><li>The results agreed with the null hypothesis in both experiments </li></ul><ul><li>Within the limitation of the study, it can be concluded that the use of self- adhesive or self-etch luting system had the same action on retention </li></ul><ul><li>The eugenol containing and Glass Ionomer containing sealer have no effect on values of bond strength </li></ul><ul><li>ZOE and Glass Ionomer did not show ideal sealing, and both groups had leakage </li></ul>
    58. 58. Future Studies <ul><li>Further research on other aged teeth with eugenol, does fresh eugenol have a greater effect? </li></ul><ul><li>Comparing total etch with different delivery systems to self adhesive cements all three with the same delivery system. </li></ul><ul><li>More studies should be conducted using resin materials to improve the bond strength to dentin with the endodontic treated teeth. </li></ul>
    59. 59. Thank You

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