Bioceramic sealers are increasingly used in endodontics due to their biocompatibility and effective sealing properties. They consist of various materials including alumina, zirconia, and calcium phosphates, offering advantages like enhanced bonding to dentin and the ability to support bone regeneration. However, challenges such as difficulty in removal for retreatment and varying solubility compliance with standards remain, necessitating further research for optimal usage.

2. Bioceramic sealers

3.  Introduction
◦ Bioceramic materials
◦ Classification
 Introduction : root canal
sealers.
 Ideal properties of root canal
sealers
 Functions of a sealer
 Bioceramic sealers
◦ Various available bioceramic
sealers
◦ Mechanism of bonding
◦ composition
◦ Advantages
◦ Limitations
 Properties of bioceramic
sealers
 Conclusion
 References
Contents:

4.  Bioceramic materials, with their biocompatible nature and
excellent physico-chemical properties, are widely used in
endodontic applications. They can function as cements, root
repair materials, root canal sealers and filling materials, which
have the advantages of enhanced biocompatibility, potential
increased root strength following obturation, antibacterial
properties and sealing ability.

5. Classification:
Bioceramics
Bioactive
Example: Glass, calcium phosphate.
They interact with surrounding
tissue.
Bioinert
Example: zirconia alumina.
They produce negligible response

6.  SEALER, root canal (cement)-A radiopaque dental cement
used, usually in combination with a solid or semi-solid core
material, to fill voids and to seal root canals during obturation.
What is a root canal sealer???

7.  The main functions of root canal sealers are :
(i) sealing off of voids, patent accessory canals, and multiple
foramina,
(ii) forming a bond between the core of the filling material and the
root canal wall, and
(iii) acting as a lubricant while facilitating the placement of the
filling core and entombing any remaining bacteria
Functions

8.  It should be tacky when mixed to provide good adhesion
between it and the canal wall when set.
 It should make a hermetic seal.[ fluid impervious]
 It should be radiopaque so that it can be visualized on the
radiograph.
 The particles of powder should be very fine so that they can mix
easily with liquid.
 It should not shrink upon setting.
 It should not discolour tooth structure.
Ideal properties-described by Grossman

9.  It should be bacteriostatic or at least not encourage bacterial
growth.
 It should set slowly.
 It should be insoluble in tissue fluids.
 It should be well tolerated by the periapical tissue.
 It should be soluble in common solvents if it is necessary to
remove the root canal filling.

10. Bioceramic sealers

11.  Bioceramic-based sealers have only been available for use in
endodontics for the past thirty years.
 The first documented use of bioceramic materials as a root canal
sealer was by Krell and Wefel.
 Bioceramic sealers include alumina, zirconia, bioactive glass,
glass ceramics, hydroxyapatite, and calcium phosphates.

12.  Tricalcium silicates
 Dicalcium silicates
 Calcium phosphate
 Colloidal silica
 Calcium hydroxide
 Zirconium oxide-radiopacifier
Composition:

13. Mechanism of bonding
Mechanism
of
bonding
Diffusion: tubular diffusion to produce mechanical
interlocking bonds
Infiltration of the sealer’s mineral content into the
intertubular dentin resulting in the establishment of
a mineral infiltration zone produced after denaturing
the collagen fibres with a strong alkaline sealer
Reaction of phosphate with calcium silicate
hydrogel and calcium hydroxide in the presence of the
dentin’s moisture, resulting in the formation of hydroxyapatite
along the mineral infiltration zone

14.  Sankin apatite,
 EndoSequence BC,
 iRoot SP,
 MTA-Fillapex ,
 Capseal I and Capseal II
Various sealers

15.  There are two major advantages associated with the use of
bioceramic materials as root canal sealers.
 Firstly, their biocompatibility prevents rejection by the
surrounding tissues.
 Secondly, bioceramic materials contain calcium phosphate which
enhances the setting properties of bioceramics and results in a
chemical composition and crystalline structure similar to tooth
and bone apatite materials, thereby improving sealer-to-root
dentin bonding.
Advantages

16.  Disadvantage of these materials is in the difficulty in removing
them from the root canal once they are set for later retreatment
or post-space preparation.
Disadvantage:

17. Biocompatibility:
 Most bioceramic based root canal sealers have subsequently
been found to be biocompatible. This biocompatibility is
attributed to the presence of calcium phosphate in the sealer
itself. many bioceramic sealers have the potential to promote
bone regeneration when unintentionally extruded through the
apical foramen during root canal filling or repairs of root
perforations.
Properties

18. Setting Time:
 Normal setting time is four hours.
 Accelerates in presence of moisture.
 However, even shorter setting times for MTA-Fillapex (66min)
have been reported

19.  Retreatability:
 EndoSequence BC Sealer is difficult to remove from the root canal using
conventional retreatment techniques, including heat, chloroform, rotary
instruments, and hand files.
 But, Sankin apatite root canal sealer is easily removed during retreatment
with and without the use of solvents.
 Solubility: According to ANSI/ADA Specification 57 , the solubility of a
root canal sealer should not exceed 3% by mass.
 Both iRoot SP and MTA-Fillapex are highly soluble, 20.64% and 14.89%,
respectively, which does not meet ANSI/ADA requirements.
 Vitti et al have reported the solubility of MTA-Fillapex to be <3%.

20.  Discolouration of Tooth Structure:
 Radiopacity:
According to ISO 6876/2001, the minimum radiopacity for a
root canal sealer is based on a reference standard of 3.00mm
of aluminium. EndoSequence BC Sealer to be 3.83 mm. Endo
CPM sealer was found to have a radiopacity of 6mm due to the
presence of bismuth trioxide and barium sulphate . Similarly,
the presence of bismuth trioxide in MTA-Fillapex gives it a
radiopacity of 7mm

21. Antimicrobial Properties:
 High ph.
 Two additional mechanisms associated with the antibacterial
efficacy of iRoot SP: hydrophilicity and active calcium hydroxide
diffusion.

22. Adhesion and strengthening of root:
 monoblock effect

23.  Bioceramic-based root canal sealers show promising results as
root canal sealers.
 However, discrepancies in the results of these studies reveal that
these sealers do not fulfil all of the requirements demanded of
the ideal root sealer.
 Further studies are required to clarify the clinical outcomes
associated with the use of these sealers
Conclusion:

24.  Bioceramic materials in Endodontics Endodontic Topics 2015, 32, 3–30.
 Afaf AL-Haddad and Zeti A. Che Ab Aziz. Bioceramic-Based Root Canal
Sealers: A Review. International Journal of Biomaterials. Volume 2016.
 K.Koch andD. Brave, “Anewday has dawned: the increased use of
bioceramics in endodontics,” Dentaltown, vol. 10, pp. 39–43, 2009.
 M. P. Ginebra, E. Fern´andez, E. A. P. De Maeyer et al., “Setting reaction
and hardening of an apatitic calcium phosphate cement,” Journal of
Dental Research, vol. 76, no. 4, pp. 905–912,1997.
 A. M. Cherng, L. C. Chow, and S. Takagi, “In vitro evaluation of a calcium
phosphate cement root canal filler/sealer,” Journal of Endodontics, vol.
27, no. 10, pp. 613–615, 2001
References:

25.  R. P. Vitti, C. Prati, E. J. N. L. Silva et al., “Physical properties of
MTA fillapex sealer,” Journal of Endodontics, vol. 39, no. 7,
pp.915–918, 2013.
 G. T. D. M. Candeiro, F. C. Correia, M. A. H. Duarte, D. C. Ribeiro-
Siqueira, and G. Gavini, “Evaluation of radiopacity, pH, release of
calcium ions, and flow of a bioceramic root canal sealer,” Journal
of Endodontics, vol. 38, no. 6, pp. 842–845, 2012.