Application of sealers during endodontic obturation pptx

Sudanese dental center
Khartoum October 2021
‫هللا‬ ‫بسم‬
‫الرحمن‬
‫الرحيم‬

Dr.Abdalazim Badraldin
Knowing the qualities and characteristics of an
endodontic sealer is critical to determining the best
selection and application for each clinical case.
Clinicians will better understand the sealer’s role in
preventing bacterial leakage, resulting in a successful
outcome in endodontic practice
A clinician has the responsibility to decide
the top priority for the patient: good sealing
or a therapeutic effect.

“I doubt very much whether there is any hollow cavity
in the body that has been plugged with as many
different materials as the root canal of a tooth.”.
Grossman 1958

♦ Exhibits tackiness when mixed to provide good
adhesion between it and the canal wall when set
♦ Establishes a hermetic seal
♦ Radiopaque, so that it can be seen on a radiograph
♦ Very fine powder, so that it can mix easily with liquid
♦ No shrinkage on setting
♦ No staining of tooth structure
♦ Bacteriostatic, or at least does not encourage bacterial growth
♦ Exhibits a slow set
♦ Insoluble in tissue fluids
♦ Tissue tolerant; that is, nonirritating to periradicular tissue
♦ Soluble in a common solvent if it is necessary to remove the root canal filling.
Properties of an Ideal Sealer
Sealers are self-hardening cements

Root canal sealers are used in conjunction
with a biologically acceptable semi-solid or
solid obturating material to establish an adequate
seal of the root canal system
The American Association of Endodontists’
Guide to Clinical Endodontics,Chicago, 2013
Function & Idea Properties
 Sealers fill voids and irregularities in the root canal, between
the core and canal wall, also fill lateral and accessory canals..

Functions & Ideal Properties
 Sealers also serve as lubricants during
the obturation process.
Sealers should be biocompatible
and well tolerated by the periradicular tissues.
Tissue healing and repair generally appear unaffected by most sealers.

 Sealers may have an adverse effect on the proliferative capability of
periradicular cell tissues, so sealers should not be placed routinely
in the periradicular tissues as part of an obturation technique.
Root canal sealers vary in radiopacity. (Silver particles) ,barium
sulfate or Bismuth trioxide are used to enhance sealers radiopacity
 Root canal Sealers designed to improve the seal provided by
the core obturation material.
 The sealer should be used in small amounts; as minimal as practical.
It should be deposited on the canal walls as a microfilm
of only a few microns in thickness.

Categorizations of root canal sealers
zinc oxide- eugenol - based Sealers
Salicylate- based Sealers
Fatty acid – based Sealers
Glass ionomer based Sealers
Silicone - based Sealers
Epoxy resin –based Sealers
methacrylate resin – based Sealers
Tricalcium silicate - based Sealers
Sealers are categorized by their composition and
composition based reaction into ;-
N.B. Some novel sealers contain fillers or ceramic powders including calcium
hydroxide, mineral trioxide aggregate (MTA), and calcium phosphate; however,
they are fundamentally composed of the above sealer matrices

From Rickert & Dixon (1931) to Grossman(1936), to. 2021
with improvement formulas
 ZOE sealers contain zinc oxide powder , eugenol liquid.
 When mixed and placed in moist root dentin, the zinc oxide and
eugenol complex to form a Zinc Eugenolate gel.
 Residual zinc oxide powder remains in the gel, forming a rigid matrix.
 ZOE-containing paraformaldehyde sealers are contraindicated
because formaldehyde causes coagulative necrosis, and residual
formaldehyde disrupts local repair of affected areas.
 The presence of free eugenol tend to weaken the set and Induces an
inflammatory response in connective tissues

Setting times
 Setting times for ZOE sealers are variable, this variations are due to the
need for water to initiate ZOE setting.
Solubility
 ISO 6876 requires less than 3% solubility of sealers in distilled water,
and ZOE sealers have met this requirement.
 sealers Solubility depends on matrix chemistry. For re-treatment,
mechanical removal of a sealer will be useful.
 ZOE sealers showed weight losses of 5.19% in halothane, over 10 min,
indicating moderate solubility in common re-treatment solvents.
Sealing Ability
 ZOE sealers demonstrate more microleakage than any other available sealers.

Antimicrobial Activity
 Zinc oxide is a well-documented antimicrobial material because it
forms a reactive oxygen species and interferes with bacterial
membrane proteins.
 ZOE sealers have better antimicrobial effects in a zone of inhibition
test for Streptococcus mutans, Staphylococcus aureus, and
Enterococcus faecalis, compared with multiple Epoxy resin-based
sealers.
 Calcium-hydroxide- based sealers proved to have a greater zone of
inhibition than ZOE sealers.
Biocompatibility and Cytotoxicity
 ZOE sealers have been shown to be both an irritant and cytotoxic
agent and activate a complement- mediated immune response as
well as significant fibroblast cytotoxicity.

Advantages—
Law cost, ease of manipulation- plasticity - radiopaque with some
germicidal properties- minimal staining –accepted working time, low setting
time in the absence of moisture.
Disadvantage-
irritation. Zinc eugenolate has the disadvantage of being decomposed by
water through a continuous loss of the eugenol. This makes ZOE a weak,
unstable material and precludes its use in bulk, such as for retrofillings placed
apically through a surgical approach. Sealing properties ???.
 ZOE sealers are also a common matrix for sealers with
therapeutic additives , Calciobiotic Root Canal Sealer, CRCS,
(Coltene/Whaledent, Cuyahoga Falls, OH, USA), is a ZOE sealer
marketed as a “calcium hydroxide sealer).
Bioseal (OGNA Pharmaceuticals, Muggiò, Italy) is a ZOE-based
sealer with added hydroxyapatite.

powder : zinc oxide 34---41.2 %
precipitated silver 25-30 %
Oleo resins 30-16%
Thymol iodide 11-12%
Liquid : oil cloves 78-80%
Canada balsam 20-22% make the sealer tacky
Advantages 1- excellent lubricating properties
2- working time more than 30 mints ratio 1:1 Completely set and
become inert within 15-30min thus reducing the inflammatory
responses compared to others.
3- germicidal
4- greater bulk than any sealer –this is ideal for condensation techniques
Disadvantages-- staining of the tooth --rapid setting time in high
heat/humidity region
According to the manufacturer’s Description
PCS regular& Extended Working Time PCS EWT

 A nonstaining sealer .Marketed as a two-paste system
Composition
Base:
Zinc Oxide , Oloe Resin ,Bismuth trioxide
barium sulfate as a radiopacifier
Thymol iodide, Oil and Waxes
Catalyst:
Eugenol, Polymerized resin, Annidalin
setting time glass slab 20 minutes,, root canal 5 minutes.
TubliSeal (SyberonEndo USA)
According to the manufacturer’s Description
Advantages :
• quick and easy mix and manipulation
• extremely lubricated
•does not stain teeth
•expands after setting

Disadvantages
- Irritate periapical tissues
-very low viscosity easy extrusion through apical foramen
-short working time,rapid set especially in the presence of moisture (used
when apical surgery is to Be performed immediately after filling).
The company has reformulated the sealer to extend working time,
it now available in auto-mix tube Tubliseal Express
TubliSeal (SyberonEndo, USA)

tg sealer(Technical&General)
According to the manufacturer’s description,
Powder:
Zinc oxide---- Thymol –iodide ---Barium Sulphate
Liquid:
Eugenol
Advantages
 does not( irritate) periapical tissues--????
Contains antiseptic and anti-inflammatory additives
 Does not stain the tooth structure …???
 Good radiopacity
 High adhesion properties ….??? Fluid-tight seal, not hermetic seal)
Easy of manipulation & application
 acceptable work time

Endofill (Dentsply Petrópolis Ind, Brazil)
Endofill is a radiopaque preparation for permanent root-canal filling.
Its composition is well tolerated by tissues…. ???
and it provides anti-inflammatory, antiseptic
actions. Before hardening, the paste penetrates
the narrowest fissures and maintains its
therapeutic effects throughout the treatment
until completely set. The final
obturation neither retracts nor resorbs…???
•Endofill is available as REGULAR or SLOW setting
COMPOSITION
Powder :
Dexamethasone Acetate 0.01%,
Hydrocortisone Acetate 1.0%,
Polyoxymethylene 2.2%, Thymol lodide 22.5%, excipient ad 100%
Liquid :Eugenol

Sealite Ultra
Powder:
Enoxolone 1%, Diiodothymol, Zinc oxide,
Radio-opacifier: silver powder.
Liquid:
Eugenol.
PROPERTIES
- SEALITE ULTRA contains Enoxolone): non
steroidal anti-inflammatory agent with
good local and systemic safety. It is used for the
relief of post-operative pain following root canal.
work cement witch perfectly fills even the smallest
canals, very thin film thickness, no disintegration,
very slow solubility, very high flexibility of handling,
adequate working time and setting time

Root Canal Sealant Based On Grossman's Formula
Antibacterial, non inflammatory
* Root canal sealing using or without gutta percha points
* Root canal filling for infected root canals
Composition:
* Zinc Oxide * Bismuth Subcarbonate*Iodoform
* Epoxy Resins* Barium Sulphate* Sodium borate
Eugenol
* Setting Time 5 - 10 Minutes*
Working Time 4 - 6 Seconds
Product Benefits:
* Antibacterial and non inflammatory
* Based on Grossman's Formula
* Radiopaque and non staining
* Excellent thermal insulation
Zical( Prevest denpro India)

Product Packaging
1 x 15g Cartridge (Base / Catalyst), 20 x Auto Mix Tips
Product Benefits
•Based on Grossman’s Formula
•Radiopaque and non staining
•Excellent thermal insulation
•Very long working time
•Excellent lubricating qualities
•Low zinc alleviate cytotoxic and inflammatory effects of the tissues???
Zical Paste-Paste Form
According to the manufacturer’s description

Endoseal (Prevest denPro India)
Product Benefits
•Perfect root canal filling material
•Long lasting antiseptic and anti-inflammatory activity
•Radiopaque
•Perfect marginal sealing
Endoseal is radiopaque, non-resorbable paste
for the permanent obturation of the root canal.
Its composition is well tolerated by the tissues
and provides anti-inflammatory, antiseptics and
germicidal actions.
Indications
Permanent root canal filling and sealing in
dental procedures with systematic insertion of
points

Pulp fill ( biodinamica)
•PULP FILL is an endodontic cement,
used as intra canal filling material.
•The formulation of PULP FILL is similar
to the one developed by GROSSMAN.

 Salicylate-based sealers are typically referred to by their marketed therapeutic
additives instead of by their composition.
 Many dental luting agents set by way of a chelation reaction.
Two of the most common chelates used in dentistry are eugenolates and salicylate.
 For eugenolates, the setting reaction starts with water that hydrolyzes the zinc
oxide to form zinc hydroxide. The zinc hydroxide and eugenol chelate and solidify.
For salicylates, the ion is calcium, usually formulated using calcium oxide.
Setting time & Solubility
 Salicylate-based sealers, have an average setting time of 58 min.
 Salicylate-based sealers met the ISO 6876 solubility requirements.

Paste A Methyl salicylate, Butylene glycol, Colophony,
Bismus , trioxide, Fumed silica, Titanium dioxide,
Fumed , silica, Tricalcium silicate,
Paste B Dicalcium silicate, Calcium oxide,
Tricalcium alminate,
Pentaerythritol rosinate, p-Toluene sulfonamide
MTA Fillapex (Angelus, Brazil)
 MTA Fillapex is a unique salicylate resin- based sealer that
contains 13.2% MTA powder. MTA Fillapex should not be
regarded as a tricalcium silicate (MTA, a bioactive ceramic) sealer
since its composition is primarily resin.

Apexit & Apexit Plus ( Ivoclar-Vivadent)
insoluble, radiopaque calcium hydroxide cement.
It does not shrink during setting and demonstrates
excellent physical and biological Properties
Working Time
If no water is added, the working time is approx. 3 hours.
The addition of water markedly reduces this time span.
Composition
Calcium salts (hydroxide, oxide, phosphate), hydrogenized
colophony, disalicylate, bismuth salts (oxide, carbonate),
highly dispersed silicon dioxide (silanized) and alkyl
ester of phosphoric acid.
Contraindication
– Retrograde obturation
– patients with a known allergy to any of the
product’s ingredients.

Apexit & Apexit Plus ( Ivoclar-Vivadent)
Side Effects
Unset Apexit Plus may cause slight irritations.
Interactions
The setting time of Apexit Plus in the root canal is dependent
upon the availability of moisture. when using Apexit Plus, make sure to
thoroughly dry the root canal system prior to performing the obturation.
Outside the mouth, on the mixing pad, Apexit Plus may remain soft for
several days, depending on the ambient humidity
The setting time of Apexit Plus is between two and five hours. In very dry
canals, the setting time can be more than ten hours.
Apexit Plus differs from Apexit in that it is supplied in a more
convenient delivery form and has a more hydrophilic formulation.

calcium hydroxide–paste to paste System.
Base: zinc oxide, calcium hydroxide butyl benzene,
sulfonamide zinc stearate.
Catalyst : barium sulfate ,titanium dioxide as radiopacifiers
resin, isobutyl salicylate, and aerocil.
In 100% humidity, it takes up to 3 weeks to reach a final set. In a dry
atmosphere, it never sets. the sealer expands while setting.
( Is SealApex soluble in tissue fluids to release the calcium hydroxide for
its osteogenic effect? And if so, does this dissolution lead to an
inadequate seal?). Ingle
similar to SealApex
Contain 40% Iodoform
Contain Iodoform& ZOE
SealApex (Sybron Endo/Kerr; Orange, Calif.)
Marketing as Calcium hydroxide –base Sealer

 Epoxy resin-based sealers are composed of low molecular weight
epoxy resins and amines and set by addition reaction between epoxide
groups attached to epoxy resins and amines to form polymer.
 an epoxy resin is a glue, the base is biphenol A-epoxy.
The catalyst is hexamethylene–tetramine.
It also contains 60% bismuth oxide for radiographic contrast
Sealing Ability
 Epoxy Resin “AH Plus”, “Leakage”, and “Sealing” were used as key words.
 Epoxy resin-based sealers have been shown by stereomicroscopy to
have moderate sealing capacity, but superior to ZOE-based sealers.
 The sealing performance of epoxy resin-based sealers can be
compromised due to leaks introduced by polymerization shrinkage.

Antimicrobial Activity
 Epoxy resin based sealers have highest antibacterial activity on
both planktonic and biofilm bacteria, but only lasting 24 hours.
Biocompatibility and Cytotoxicity
 Resin sealers have limited biocompatibility when unset due to residual
monomer and formaldehyde.
No genotoxic activity was seen after 24 hours.
Epoxy sealers like AH 26 release formaldehyde even two days after being mixed.
AH Plus is modified such that formaldehyde is decreased.
AH Plus induced milder inflammatory response than a ZOE sealers
in the periapical tissue.
 Epoxy resin based sealers have a less antimicrobial activity compared
with Salicylate-based sealers and ZOE sealers.

Powder Bismuth oxide, Hexamethyleneteramine,
Silver powder, Titanium oxide
Paste Bisphenol A diglycidyl ether
Advantages
High radiopacity, low solubility, slight shrinkage,
tissue compatibility.???(after 24 hours)
Disadvantages
Formaldehyde release, extended setting time [24hours], and staining.
AH 26 (Dentsplysirona)

The manufacturer of AH26 retained the epoxy resin "glue”
of AH26 but added new amines to reduce
the elimination of Formaldehyde and maintain the
natural color of the tooth. Its shade and color stability
make it material of choice where aesthetic demands are high.
AH Plus comes in a paste–paste system,
Paste A –epoxy resin , calcium tungstate –
Zirconium Oxide , silica , Iron Oxide
Paste B – adamantaneamine-N ,N-Dibenzyl-5-oxanonane-diamine ,
1,9,TCD-diamine, Calcium Tungstate,
Zirconium Oxide, Silica, Silicone oil
 The setting time is 36 to 48 hours at body temperature
and 5-7 days at room temperature.
AH PLUS (Dentsply Sirona International Germany)

Adseal (Meta Biomed, Korea)
Application
• Permanent Root Canal Sealing
• Thermal obturation
Composition
 Base –Epoxy oligomer resin,
Ethylene glycol salicylate, Bismuth subcarbonate
Advantages
 Excellent biocompatibility…???
 Easy to mix paste-paste
 Hermetic stealing ability ???
 Nonstaing to the teeth.
 Insoluble in tissue fluids
 Good Radiopacity

ViOseal
• An epoxy resin based root canal sealer
• Paste/paste form in dual syringe
• Excellent sealing property
• Biocompatible
SPIDENT CO. USA

Any - Seal
ADVANTAGES
-Excellent sealing ability
-Excellent biocompatibility
-Non-staining to the resin
-Good radiopacity
-Easy and fast handing
-Working time 1hr ~ 1hr 30min
-Setting time : 3hr ~ 4hr at 37°C
Mediclus .. Korea

Ketac-Endo (3M/Espe; Minneapolis, Minn.)
Powder
Calcium alminium lanthanum fluorosilicate glass,
Calcium volframate, Silicic acid, Pigments
Liquid
Water, Tartaric acid, Polyethylene polycarbonic acid/
Maleic acid, copolymer
Properties
Ease of manipulation radiopacity,
Best bond to dentin,
Fewest voids,
Lowest surface tension,
Best flow.
Their greatest concern was the problem of removal in the event of re-treatment
since there is no known solvent for glass ionomers . Experimental Sealer .

Calcium Silicate – Based Sealers
 Calcium Silicate –based sealers based on mineral trioxide aggregate (MTA).
 Calcium silicate sealers include some of the same hydraulic compounds found
in Portland cement, primarily tricalcium silicate and dicalcium silicate powder.
 1878, Dr. Witte, German –used Portland cement to fill root canals.
 1990, Mineral Trioxide Aggregate (MTA) was introduced.. Torabinejad & White : USA
 Understanding of the specificities and the clinical perspectives of the Calcium
Silicate based sealers is important for successful treatment outcomes.

Calcium Silicate – Based Sealers( CSBS)
 CSBS are usually formulated from synthetic calcium silicate or from Portland/MTA.
C O H E N ’ S
P AT HW AY S of the
PULP 11

 Calcium silicate cements react with body fluids (or synthetic fluids)
to release calcium and hydroxide ions this reaction elevates the pH(about 12) .
The high pH causes the phosphate ions in body fluids to precipitate
hydroxyapatite at the surface (mineral infiltration zone ).
 The calcium and hydroxide ions continue to be released for about
one month after setting.
 Tricalcium silicate-based sealers have been reported to cause
the deposition of apatite-like crystals in the apical and middle
thirds of canal walls
International Standards Organization. ISO 6876.

C O H E N ’ S
P AT HW AY S of the
PULP 11

Setting times and solubility
 Setting times for tricalcium silicate-based sealers, exceed one month.
 The solubility may be attributed to the formation of calcium hydroxide during setting
 Setting times of the Calcium Silicate based sealers depend not only on
formulation, but also on root canal moisture, when the root canal is dry, setting time
tends to increase.
 Applying heat during root canal filling resulted in an extended setting
time for premixed CSBS

Calcium Silicate – Based Sealers (CSBS)
 CSBS flowability should allow good sealer distribution into the
ramifications/irregularities of the root canal space.
flowability
 CSBS flowability considered as overall comparable to the
conventional sealers, especially epoxy resin-based sealers.
 Wettability reflects the spreading ability and the capability
of sealers to penetrate into both the main and lateral
canals, as well as into the dentinal tubules .
 CSBS are hydrophilic, this might induce a goo spreading
ability on wet root canal walls
Wettability

Calcium Silicate – Based Sealers(CSBS)
Film Thickness
 CSBS have high or slightly above the standard values of sealers film thickness.
 According to ISO6876/2012 and ANSI/ADA no 57, film thickness
must not exceed 50 m for sealers
 CSBS dimensional stability is overall better than the
one of conventional sealers.
Dimensional Stability
 The better dimensional stability
of CSBS is often highlighted as
the main reason for allowing their
use with cold hydraulic condensation, especially the
single-cone (SC) technique. Materials 2021, 14, 3965

Retreatability
 CSBS are known to be hard upon setting, create hydroxyapatite crystals
upon their interface with dentin, and they are capable of penetrating
into the dentinal tubule.
These properties may render retreatment procedures difficult.
Adhesion–Interaction with Dentin Walls
 CSBS form a specific interfacial layer at the dentin walls known as the
mineral infiltration zone.

Biological Properties
Radiopacity
 The ISO 6876 standard establishes 3mmof aluminum (Al)
as the minimum radiopacity for 1 mm root canal sealer
sample thickness.
 The standard specifications are respected
in all CSBS formulations.
 CSBS are biomaterial , non-genotoxic and non-cytotoxic and
also exhibiting antimicrobial properties and inducing appropriate host
response in their specific use.

Single-paste ( gaining popularity in clinical practice because they are easy to use)
Tricalcium silicate-based sealers available in:-
 iRoot SP , EndoSequence BC , Total Fill BC , and Edge Endo Sealer ,
CeraSeal , Endoseal MTA , Bio-C Sealer
 The setting mechanism of single-paste tricalcium silicate-based
sealers is water absorption from dentin tubules ,with the
concomitant formation of HA at the surface within the canals

Powder- liquid systems :
NeoMTA Plus, BioRoot RCS, and Endo CPM.
Tricalcium silicate-based sealers available in:-
 Some companies have marketed the tricalcium silicate materials as “bioceramics” or
“biosilicates”, but these terms are too general since many dental materials are bioceramics
 The tricalcium silicate materials are distinguished by their bioactivity; that is, their
ability to form hydroxyapatite on their surface and an osteogenic effect

Clinical Application of CSBS
 CSBS need water to initiate the hydration reaction that conditions
their setting process, and also their biological properties
 According to the manufacturers, the dentinal tubules’ moisture initiates
the setting of premixed formulations. Gently drying the root
canal before obturation must be avoided.
 The use of intracanal micro-suction to empty the canal before
the use of one sterile paper point could help
preventing over-dehydration.
 A final rinse with ethanol is contra-indicated when using CSBS
 It’s suitable to perform a final rinse with sterile water to flush out the last
irrigant before root canal drying .

 Until now There is no available evidence supporting the use of specific
pre-impregnated gutta-percha cones with CSBS.
 All the endodontic filling techniques are never “void-free”
regardless of the type of sealer used.
 Single cone obturation induces a higher void ratio compared to
warm obturation techniques, especially in oval or wide root canals.

 Lentulo spiral usage at low speed (around 700–800 rpm) or flexible injection
tip before master cone insertion.
 Techniques can be used to place CSBS into the root canal system,
depending on the formulation and the anatomy:-
 Coating the master cone with CSBS followed by its slow insertion
to the full working length.
This technique might be insufficient when dealing with oval or wide canals.
Accessory cones can also be used to complete the sealer distribution.

 Temperature rise (especially above 100 C) may lead to a change in CSBS’ physical
properties, especially their flowability, setting time, and adhesion to dentin walls.
 Based on the available knowledge, Endosequence® BC Sealer™ HiFlow®
and EndoSequence® BC Sealer™ formulations could be used with heat ,
but not all CSBS can. BioRoot™RCS is contra-indicated with warm
gutta-percha obturation
 CSBS may be removed with difficulty in the case of retreatments
 studies assessing CSBS retreatability have shown that apical patency
could be properly achieved when the obturation of the previous treatment
reached the full working length.
 Use of ultrasonic endo tips in retreatment cases are practically useful.

Mineral Trioxide Aggregate - developed by Dr. torabinejad 1990s USA
Composition. white & Grey color
Grey --- Tricalcium Silicate, Dicalcium Silicate ,
Bismuth Oxide ,Calcium
Sulfate,Tetracalcium aluminoferrite
White ---- same as grey color except
lack of tetracalcium alumino-ferrite
Properties:
-setting time approx.3 hours .
- pH 12.5 when set so it has biological
& histological properties Similar to calcium hydroxide.
- high compressive strength and produces hard
setting non resorbable surface.
- it set in a moist environment (hydrophilic in nature )
- low solubility -resistant to marginal leakage.
- biocompatible- Bacteriostatic.
ProRoot MTA Dentsply Sirona, Johnson City, TN, USA
MTA-based Root End Filling Materials

MTA-based Root End Filling Materials
ProRoot MTA Dentsply Dentsply Sirona,
Johnson City, TN, USA
Disadvantages - Difficult to manipulate
- long setting time - costly
Indication of use : - Apexification - Root resorptions
- Root perforations - Pulp capping
- Root end filling material ( grafting endodontic)
- not used as a sealer
Precautions :
1-MTA material should be stored in dry area and kept in
closed container to avoid moisture.
2- Material should be immediately placed after mixing to prevent
dehydration during setting.
4- Working time is about five minutes, to increase the time working, the mixed
material should be covered by moist gauge to prevent evaporation or add
small drop of water during capillary condensation technique.

iRoot Innovative BioCeramix, Canada)
 In North America marketed as
EndoSequence® BC.(Brasseler USA).
 The first premixed and ready-to-use
hydraulic calcium silicate–based material(2007).
 In Europe marked as TotalFill® BC
sealer™ by(FKG Dentaire, Switzerland).

One-Fill ( Mediclus .. Korea )
 One-fill is a premixed ready-to-use, injectable bioceramic cement paste
based on a calcium silicate compounds composition, developed for
permanent root canal filling and sealing applications.
Compositions
• Calcium Silicate compounds. Zirconium oxide. Hydrophilic
polymer ( thickening agents).

iRoot EndoSequence® BC TotalFill® BC
The working time for these materials can be more than 4 h at
room temperature, while the setting time is 4 h.

Hydraulic Calcium Silicate – Based Sealers
CeraSeal
Benefits
•anti-microbial
•optimal biocompatibility
•excellent sealing ability
•Unique stability
CeraSeal has high pH (12.73), it proves high biocompatibility
Shorter Setting time
•prevents from wash-out phenomenon
The wash-out phenomenon can happen if the MTA or MTA based sealer is not
sufficiently cured or the exudate is produced in the root canal. Consequently,
the root canal sealer is washed away by physical forces. CeraSeal prevents by
curing faster than other sealers.
(Meta Biomed, Korea)

Hydraulic Calcium Silicate – Based Sealers
Well-Root
A Convenient premixed ready –t0-use
,injectable
calcium aluminosilicate compound paste.
Setting Time According to the manufacturer’s description
25 min ,measured according to ISO in 100% humidity
condition . In normal root canals the setting time
can be more than 2.5 hours.
Composition
- Calcium aluminosilicate compound.
- Zirconium Oxide.
- Fillers and thickening agent
A case obturated by gp & well-Root ST sealer

Cerafill RCS
Product Benefits
•Bioceramic technology for optimal results
•Permits adequate working time.
•Syringe for direct application
•Optimal flowability allows the sealer to fill difficult access areas
Indications
•Permanent root canal obturation
•Root canal sealer
A ready to use injectable premixed filling and sealing material which is based on
the bioceramic technology. It is a alumina free calcium silicate based material with
excellent handling characteristics and superior physical properties. It is a
radiopaque material which requires water to set and harden.
(Prevest denPro India)

nRoot – Denjoy- China
Zirconium oxide, calcium silicates, calcium phosphate,
calcium hydroxide & filler agents

Clinical Selection
 Pulp diagnosis as vital or necrotic is important for selection of an endodontic
sealer for clinical use.
Vital pulp (pulpitis) cases
 The therapeutic effects of sealers are not necessary
under the asepsis technique NSRCT,
therefore, sealers with effective sealing, are a good choice.
Necrotic pulp cases
 A medicated sealer to kill bacteria should increase the chances of long-term success.
 In, cases with large apical radiolucency, the therapeutic effects of CSBS are useful
 The technical quality of the coronal restoration is more important
than the technical quality of the endodontic treatment for
apical periodontal health.

Ref.
1- C O H E N ’ S P AT HW AY S of the PULP 11
2- Ingle’s endodontics 7
3-Comprehensive Review Of Current Endodontic Sealers
Takashi Komabayashi et AL Dental Materials Journal 2020; 39(5): 703–720
4-Bioceramic-Based Root Canal Sealers:A Review
Afaf AL-Haddad and Zeti A. Che Ab Aziz…. Hindawi PublishingCorporation
International Journal of Biomaterials
Volume 2016, Article ID 9753210, 10 pages http://dx.doi.org/10.1155/2016/9753210
5- Calcium Silicate-Based Root Canal Sealers:A Narrative Review
and Clinical Perspectives…Germain Sfeir et al…. Materials 2021, 14, 3965
6- Antimicrobial activities of different bioceramic root canal sealers on various bacterial
specie…. Melek Gürel, et al…International Journal of Applied Dental Sciences 2016; 2(3): 19-22
7- Journal section: Operative Dentistry and Endodontics PublicationTypes: Research
Solubility and pH of bioceramic root canal sealers: A comparative study Claudio Poggio et al
8- Clinical Outcome of Non-Surgical Root CanalTreatment Using a Single-coneTechnique with
EndoSequence Bioceramic Sealer:A RetrospectiveAnalysis…..Elizabeth A.et AL
JOE —Volume -, Number -, - 2018 Clinical Research

Ref.
9- Comparative Evaluation of Physical and Chemical Properties of Calcium Silicate-Based
Root-End Filling Materials (MineralTrioxide Aggregate and Biodentine): An in vitro Study
Shilpa Kumari et AL …© 2018 Indian Journal of Dental Sciences |
Published byWolters Kluwer – Medknow
10- Endodontic sealers based on calcium silicates: a systematic review
David Donnermeyer et al…. Odontology (2019) 107:421–436
11- Outcome of Root CanalTreatments Using a New
Calcium Silicate Root Canal Sealer: A Non-Randomized ClinicalTrial
Angelo Zavattini et AL…J. Clin. Med. 2020, 9, 782 2 of
12- Physico-Chemical Investigation of Endodontic Sealers Exposed to Simulated Intracanal
Heat Application: Hydraulic Calcium Silicate-Based Sealers
David Donnermeyer et al….. Materials 2021, 14, 728.
https://doi.org/10.3390/ma14040728
13- Physicochemical and Antibacterial Properties of Novel, Premixed Calcium Silicate-Based
Sealer Compared to Powder–Liquid Bioceramic Sealer. Naji Kharouf et al…..
J. Clin. Med. 2020, 9, 3096; doi:10.3390/jcm9103096
14- Physicochemical Properties of Epoxy Resin-Based and
Bioceramic-Based Root Canal Sealers. Ju Kyung Lee et al
Hindawi…Bioinorganic Chemistry and Applications
Volume 2017, Article ID 2582849, 8 pages
https://doi.org/10.1155/2017/2582849

Khartoum 2023

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