Applications of Bioceramic Materials in Endodontic Treatment.pptx

Bioceramic Sealers’ Applications
in
Endodontic Treatment
Sudanese dental center
Khartoum October 2021
‫هللا‬ ‫بسم‬
‫الرحمن‬
‫الرحيم‬

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

Bioceramic – Endodontic Sealers
Dr.Abdalazim Badraldin
 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).

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

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.

Properties
 Bond to dentin
The material entered into the dentinal tubules creating a biochemical bond

Properties
 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.

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

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).

 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

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.

 The use of hydraulic cements reverse irreversible pulpitis when used
as a dressing over partial or full pulpotomies in permanent teeth.

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

 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.

 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.

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

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

Bioceramic – Sealers Obturation Techniques
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

Hydraulic Condensation Obturation
Techniques
cold passive hydraulic condensation Warm hydraulic condensation
1- Basic technique
2- Advanced technique

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.

Techniques
Basic technique

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.

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

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.

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

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.

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

Conclusions
Thermal treatment did not lead to any substantial chemical changes

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.

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

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

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

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

gutta-percha cone-mediated ultrasonic activation
Kim et al. JOE —Volume -, Number -, - 2017
Voids

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.

Conclusion
 Tubular penetration was higher in the premixed endodontic bioceramic
sealers than powder and liquid types
Dentinal Tubules penetration

Applications of Bioceramic Materials in Endodontic Treatment.pptx

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