Endodontic sealers and irrigating solutions /prosthodontic courses

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

SealersSealers
Functions:Functions:
Filler for canal irregularities.Filler for canal irregularities.
Assist in microbial controlAssist in microbial control
LubricantsLubricants
Adheres to dentinAdheres to dentin

SealersSealers
Characteristics:Characteristics:
BiocompatibleBiocompatible
-Early toxicity-Early toxicity
Resorbable in PAResorbable in PA
tissuestissues
-Breakdown products-Breakdown products
might alter healingmight alter healing
RadiopaqueRadiopaque

SealersSealers
Sealer GroupsSealer Groups
ZOEZOE
Ca(OH)2Ca(OH)2
G.I.G.I.
Resin BasedResin Based
Methacrylate basedMethacrylate based

SealersSealers
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

SealersSealers
ZOEZOE
Rickert’sRickert’s
ProcosolProcosol
GrossmanGrossman
WachWach
TublisealTubliseal
N2N2

SealersSealers
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

SealersSealers
Ca(OH)2Ca(OH)2
SealapexSealapex
CRCSCRCS
ApexitApexit

SealersSealers
G.I.G.I.
- Cause little tissue irritation- Cause little tissue irritation
- Low toxicity- Low toxicity
- Adhesive failures- Adhesive failures

SealersSealers
G.I.G.I.
Ketac EndoKetac Endo

SealersSealers
-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

SealersSealers
AH26AH26
AH plusAH plus
DiaketDiaket
EndofillEndofill

SealersSealers
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

SealersSealers
sealers:sealers:

SealersSealers

SealersSealers
Sealers concernsSealers concerns::
ToxicityToxicity
SealSeal

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
--

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

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

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

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

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

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

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

SealersSealers
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

SealersSealers
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.

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

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.”

Cleaning and shaping depending on:Cleaning and shaping depending on:
1.1. Rotary InstrumentsRotary Instruments
2.2. 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

Must be ALWAYSMust be ALWAYS
kept inside the canalkept inside the canal
Should NEVER beShould NEVER be
delivered underdelivered under
pressurepressure

NaOClNaOCl
ChlorhexidineChlorhexidine
EDTAEDTA
MTADMTAD

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

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.

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

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

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

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

MTADMTAD
Recommended inRecommended in
persistent pulpal/PApersistent pulpal/PA
infections.infections.

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