ENDODONTIC SEALER , CLASSIFICATION AND TYPES

1. ENDODONTIC
SEALERS
GUIDED BY
DR. ANURAG JAIN
DR. SONAL BANSAL
DR. SAURABH MANKELIYA
DR. AMIL SHARMA
DR.TANYA KOHLI
SECOND YEAR PG

2. CONTENTS
 INTRODUCTION
 HISTORY
 CLASSIFICATION
 CONCEPTS/MECHANISM OF SETTING
 COMPOSITION OF VARIOUS SEALERS
 LITERATURE REVIEW- PROPERTIES OF SEALERS
 SUMMARY
 CONCLUSION
 REFERENCES

3. INTRODUCTION
– A successful root canal therapy requires complete obturation of the root canal system,
thus achieving a fluid tight seal.
– The current accepted method of obturation employs a solid or semisolid core such as
gutta-percha and a root canal sealer.
– Gutta-percha has no adhesive qualities to dentin regardless of the obturation
techniques used.
– Therefore, root canal sealers play a major role in achieving the fluid tight seal by filling
the accessory and lateral canals, voids, spaces and irregularities between gutta-
percha.

4. – The choice of sealer is not only dependent on its ability to create a sound seal,
but it must also be well tolerated by the peri-radicular tissues and be easy to
manipulate to achieve its optimum physical properties.
– Even though predictable clinical results have been obtained with the use of
non-bonding root canal sealers, there has been a continuous search for
alternative sealers that bonds to root canal dentin as well as filling materials.
– The quality of the seal obtained with gutta-percha (GP) and conventional zinc
oxide eugenol (ZOE) sealers is quite far from being perfect.

5. – GP and conventional sealer limitations:
– Hence, several new resin cement sealants have been developed to be used
instead of ZOE, thereby improving the root canal seal and imparting it more
strength as compared to the conventional materials.
Inability to strengthen the root, as it does not adhere to the
dentin
Inability to control microleakage
Solubility of the sealer

6. Silicon-based sealers
• well tolerated by tissues
• low water sorption,
• potential of forming
monoblock, thus
reinforcing root canal.
Epoxy resin-based
sealers
• adhesion to dentin
• lower rates of water
solubility.
Mineral trioxide
aggregate -based
sealers
• predilection toward
mineralization.

7. PROPERTIES OF SEALERS
1. make a hermetic seal
2. be tacky and preferably adhesive to dentin and obturation material
between it and the canal wall when set
3. contain fine powders, preferably for anatomical accommodation
4. radiopacity
5. dimensionally stable with limited changes before and after setting
6. color stable
7. bacteriostatic or antibacterial

8. 8. set slowly enough for the obturation procedure
9. insoluble in tissue fluids
10. biocompatible, including non-mutagenic, non-sensitizing, and
noncytotoxic after setting
11. capable of removal for retreatment by chemical or mechanical
means
12. preferably bioactive, stimulating the formation of hydroxyapatite in
contact with body fluids

9. HISTORY
•1931 –
ZOE
cement by
Rickett.
•1952 – by
Bernard –
Biocalex.
•1955 –
Scheufere
- resin
based
Diaket
sealer.
1956 –
Grossman’
s non-
staining
ZOE sealer
1960 –
Withtelle
and Lim -
Hydron.
1961 –
Tubliseal
modificati
on to
Ricket’s
formula.

10. •1965 –
Nybord and
Tullin
Kloropercha.
1973 –
N2 by
Sargenti
1976 –
Putford –
ketac endo
sealer.
1985 –
Browne –
CaPo4
cement.
1990’s –
bioceramics.
2004 –
Epiphany
and
gutta
flow

11. CLASSIFICATION
Messing’s classification
Grossman’s classification
Cohen’s classification
Ingle’s classification
Clark’s classification
Harty FJ classification

12. MESSING’S CLASSIFICATION
1. Diaket
2. AH-26
3. Chloropercha + Eucapercha
4. Nogenol
5. Hydron
6. Endofil
7. Glass ionomer
8. Poly carboxylate
9. CaPO4 cements
10. Cyanoacrylate
Silver containing
i. Kerr sealer (Ricket 1931)
ii. Procosol radio-opaque Ag cement
(Grossman 1936)
Silver free cement
i.1.Procosol non staining cement
(Grossman 1958)
ii.2. Grossman sealer (Grossman 1974)
iii.3. Tubliseal (Kerr, 1961)
iv.4. Wach’s paste (Wach 1925)
1. Diaket – A
2. N2
3. Endomethasone
4. SPAD
5. Iodoform paste
6. Riebler’s paste
7. Mynal cement
8. Ca(OH)2 paste
(Lanes 1962)
9. Ca(OH)2 paste
(Frank, 1962)
(Biocolex)
10. Endofloss
NON- EUGENOL EUGENOL MEDICATED

13. GROSSMAN’S
CLASSIFICATION
• Zinc oxide resin cements
• CaOH2 cements
• Paraformaldehyde cements
• Pastes
INGLE’S CLASSIFICATION
• Cements
• Pastes
• Plastics
CLARK’S CLASSIFICATION
• Absorbable
• Non-absorbable

14. COHEN’S CLASSIFICATION
Type I: Material intended to be used with
core material.
• Class 1: includes materials in the form of
powder and liquid that set through a non-
polymerizing process.
• Class 2: includes materials in the form of
two pastes that set through a polymerizing
process.
• Class 3: includes polymers and resins that
set through polymerization.
Type II : material intended to be used
with or without core material or sealer.
• Class 1: powder liquid non-polymerizing
• Class 2: paste and paste non-polymerizing
• Class 3: metal amalgams
• Class 4: polymer resin systems –
polymerization.

15. HARTY FJ’S CLASSIFICATION
1. Zinc oxide eugenol based
2. Resin based
3.GP based cements:
Solutions of GP in organic solvents.
Eg: Chloropercha, Eupercha
4. Dentin adhesive materials
Eg: cyanoacrylate cements, GIC, polycarboxylate cements, CaPo4,
composite materials.

16. 5. Materials to which medicaments have been added:
a. those in which strong disinfectants have been added to reduce
post operative pain.
Eg: paraformaldehyde, corticosteroid preparations.
b. those in which calcium hydroxide has been added to induce
cementogenesis and dentinogenesis at the foramen, creating a
permanent biological seal.
Eg: calcibiotic root canal sealer (CRCS), biocalex, sealapex

17. – METHACRYLATE RESIN BASED SEALERS:
1.First generation – Eg: hydron
Second generation – Eg: EndoRez
1.Third generation – Eg: epiphany
Fourth generation – Eg: MetaSEAL, RealSEAL

18. BASED ON COMPOSITION

19. MECHANISM OF
SETTING

20. CHELATE FORMATION:
• Several luting agents set by means of a chelation reaction, by forming metal
complexes with the polydentate (usually organic) ligands.
• Two of the most common chelates used in dentistry are eugenolates and
salicylates.
• 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.
Fatty acids have also been used as ligands, in conjunction with zinc oxide.

21. 1. Zinc oxide-eugenol-based sealers
• The zinc oxide-eugenol sealer formula developed by Rickert and
Dixon in 1931 became Kerr sealer, and the formula developed by
Grossman in 1936 became Proco-Sol sealer (StarDental,
Lancaster, PA, USA).
• ZOE sealers contain zinc oxide powder and eugenol liquid, an
essential oil derived from cloves.

22. – Grossman’s original formula contained zinc oxide, staybelite resin, bismuth
subcarbonate, barium sulfate, and sodium borate (anhydrous) with eugenol as
the liquid component. It has been marketed as Procosol sealer, as well as other
product names.
– Roth’s 801 sealer (Roth’s Pharmacy, Chicago, IL) is essentially the same as
Grossman’s original formulation, with the substitution of bismuth subnitrate for
bismuth subcarbonate. Eugenol is used as the liquid of the sealer.

23. • Rickert’s formula was an early zinc oxide-containing sealer. Its major drawback
was the staining of tooth structure from the silver that was used for
radiopacity.
• It was marketed as Kerr’s Pulp Canal Sealer (Sybron Endo/Kerr, Orange, CA).
• A major disadvantage was its rapid setting time, especially with heat and in
regions with high temperatures and high humidity.
• To overcome this, Pulp Canal Sealer EWT (Extended Working Time) (Sybron
Endo/Kerr) was introduced with a working time of 6 hours

25. • Tubli-Seal (Sybron Endo/Kerr) is a two-paste system contained in two separate
tubes.
• Developed as a non-staining alternative to the silver-containing Pulp Canal
Sealer.
• Tubli-Seal is easy to mix but has the disadvantage of rapid setting time.
• Tubli-Seal EWT has the same properties as the regular setting Tubli-Seal but has
an extended working time

27. • Wach’s cement (Roth International Inc., Chicago, IL) consists of a powder of
zinc oxide, bismuth subnitrate, bismuth subiodide, magnesium oxide, and
calcium phosphate.
• The liquid contains oil of cloves, eucalyptol, Canada balsam, and beechwood
creosote.
• The liquid gives Wach’s cement a rather distinctive odor of an old-time dental
office.
• It has the advantage of having a smooth consistency, and the Canada balsam
makes the sealer tacky.

28. • Medicated Canal Sealer (Medidenta International, Inc.) was developed by Martin.
• This sealer contains iodoform for antibacterial purposes and is to be used with
MGP gutta-percha, which also contains 10% iodoform.

29. • When mixed and placed in moist root dentin, the zinc oxide and
eugenol form an amorphous gel and the residual zinc oxide powder in
the gel, forms a rigid matrix.
• A ZOE-containing paraformaldehyde sealer was developed but was
unsuccessful because formaldehyde caused coagulative necrosis,
disrupted local repair of affected areas and was toxic to peri-radicular
tissues and hence contraindicated.
• Sargenti introduced N2 sealer in 1973, which contained lead and
mercury. These metals were reported to have migrated to distant
organ systems, from the radicular spaces, therefore it was not cleared
by the U.S. Food and Drug Administration.

30. ZOE sealers:

32. 2. Salicylate-based sealers
• Salicylate-based sealers are referred by their marketed
therapeutic additives instead of their composition.
• For example, Sealapex (Kerr) and Apexit/ Apexit Plus (Ivoclar
Vivadent, Schaan, Lichtenstein) are examples of a calcium-
hydroxide-containing salicylate sealers.
• Calcium hydroxide [Ca(OH)2] is both alkaline and antimicrobial,
desirable qualities for a therapeutic sealer.

33. • However, calcium hydroxide does not set and is soluble in water. It must be used
within a matrix to be an effective sealer.
• Sealers containing calcium hydroxide were intended to promote osteogenesis and
cementogenesis as well as create an antimicrobial environment. The solvation of
calcium hydroxide is required if therapeutic effects are to be achieved.
• MTA Fillapex (Angelus, Londrina, Brazil) is a unique salicylate resin based sealer that
contains 15% MTA powder.
• It should not be regarded as a tricalcium silicate (MTA, a bioactive ceramic) sealer
since its composition is primarily resin.

34. • CRCS (Calciobiotic Root Canal Sealer; Coltene/ Whaledent/Hygenic, Mahwah,NJ)is
a calcium hydroxide containing sealer with a ZOE–eucalyptol base.
• It is a slow setting sealer, especially in dry or in humid climate. It may require up
to 3 days to fully set.
• Beltes et al. did an in vitro evaluation of cytotoxicity of calcium hydroxide-based
root canal sealers and reported that, Sealapex > CRCS > Apexit.
• Vitapex (NEO Dental International, Inc, Federal Way, WA) is a sealer, which was
developed in Japan, and contains, not only calcium hydroxide, but also 40%
iodoform and silicone oil among other ingredients.

35. 3. Fatty acid-based sealer
• Fatty acids are used instead of eugenol as chelating agents, although the structure is less
defined and consistent than with eugenolates and salicylates.
• Canals-N (Showa Yakuhin Kako) is a fatty acid-zinc oxide sealer that uses linoleic acid, iso-
stearic acid, and rosin.
• Nogenol (GC America, Alsip, IL, USA) is another fatty acid-zinc oxide sealer made with lauric
acid. to overcome the irritating effects of eugenol.
• It is a two-tube, base and catalyst system. Hydrogenated rosin, methyl abietate, lauric acid,
chlorothymol, and salicylic acid in the catalyst accelerate the setting time.

36. IONOMER FORMATION
1. Glass ionomer-based sealers
• Glass ionomer sealers are made by mixing fine silicate glass powder
with polyacrylic and related acids.
• When mixed, they form repeating subunits of organic monomer and
inorganic ions, creating an ionomer.
• Recent developments in experimental GIC sealer formulations are
KT-308, ZUT and Activ GP.

37. • KT-308 is conventional GIC with increased radiopacity and extended
working time.
• ZUT is KT-308 combined with antimicrobial agent, a silver containing
zeolite (0.2-20% weight).
• Activ GP (Brasseler USA, Savannah, GA) consists of a glass ionomer
impregnated gutta-percha cone with a glass ionomer external coating and
a glass ionomer sealer.
• They are available in 0.04 and 0.06 tapered cones.

38. • This single cone technique is designed to provide a bond between the
dentinal canal wall and the master cone to form a monoblock.
Advantages:
• It is technically less demanding than traditional methods of effecting
apical seal.
• It has an inherent potential for providing a more stable apical seal.
• Due to bonding properties, glass ionomer may provide physical support
for resisting root fracture.

39. • Short working time and fast set are both factors, which contribute to the fact
that GICs are often used in combination with a single cone technique.
• The single cone technique in combination with GIC might therefore be the
reason for the more extensive leakage.
• It has been shown that, it takes more time to remove a GIC sealer than a
conventional sealer during retreatment procedures.
• When GIC sealer is used in combination with gutta-percha, gutta-percha can
be dissolved and then the GIC can be removed ultrasonically from the canal
without leaving excessive amounts of residue on the canal walls.

40. Polymer Formation By Addition Reaction
• Silicone and epoxy resin-based sealers both polymerize by addition reactions.
• Addition reactions are differentiated from other polymerization reactions because they
co-generate byproducts (usually water).
• Silicone-based sealers form a three-dimensional polymer network by addition
polymerization as a series of cross-linkage between divinyl polysiloxane and poly methyl
hydrosiloxane with a platinum salt as the catalyst.
• Epoxy resin-based sealers follow a more traditional organic addition reaction, where
epoxide monomers react with amines to create a rigid material.

41. 1. Silicone-based sealers
• In 1972, Davis et al. used injectable silicone impression material into the
prepared root canals.
• They are composed of polymethyl vinyl siloxane containing a platinum salt
and polymethyl hydrogen siloxane and set by addition reaction between
vinyl groups attached to polydimethylsiloxane chain and hydrosilyl groups
attached to polydimethylsiloxane chain, forming polymer.
• GuttaFlow is triturator-mixed and requires the use of a single master cone
whereas GuttaFlow 2 and RoekoSeal are auto-mix.

42. – Endofill is an injectable silicone resin sealer used in combination with core
material or as a sole filling material to be injected into canal space with pressure
syringe.
– It contains silicon monomer, silicon based catalyst and bismuth subnitrate
(radiopacifier).
– The catalyst is tetraethyl orthosilicate and poly-dimethyl siloxane and the
setting time is 8-90 minutes.
– It has low viscosity, exhibit good adaptation to the tooth structure and low
toxicity. However it is difficult to remove from canal and exhibit shrinkage upon
setting.

43. • RoekoSeal is available in an automix syringe/ single dose package.
• It has excellent flow properties and is extremely biocompatible.
• The extremely low film thickness of 5 μm allows the sealer to flow into tiny
crevices and dentinal tubules.
• The solubility - virtually zero and is highly radiopaque for an excellent x-ray
evaluation.
• It does not shrink but actually expands slightly (0.2%) - outstanding seal with
the canal walls.
• It does not form a chemical bond with dentin, which is an advantage for
retreatment.

44. • Gutta percha milled to a low grain size is mixed into components of the
silicone sealer [Gutta-flow (Coltene Dental, USA)].
• It has extraordinary chemical and physical properties that offer maximum
sealing quality and biocompatibility.
• It contains small gutta-percha particles with a size of <30μ as filler.
• The material is flowable and sets within 10 min.
• The material flows into the smallest dentinal tubules, because of the small
particle size (<0.9 μm) of the GuttaFlow matrix filler.

45. 2. Epoxy resin-based sealers
• Epoxy resin was invented in 1938 by P. Castan, a Swiss chemist of de
Trey (Zurich, Switzerland), and AH 26 was developed by the same
company during 1940s.
• In 1993, Spångberg et al. reported that AH 26 releases
formaldehyde, which recommended transition from AH 26 to AH
Plus, which does not release formaldehyde. Other disadvantages are
staining and an extended working time.
• On the other hand, AH 26 does not seem to be affected by moisture,
and will even set under water.

46. • AH 26 and AH Plus (Dentsply Sirona, Konstanz, Germany), 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.
• AH 26 exists in a powder-paste mixture while AH Plus exists in a paste-paste
mixture. When sold in an automatic mixing syringe, AH Plus is known as AH
Plus Jet.
• In the United States, AH Plus and AH Plus Jet are sold as ThermaSeal Plus
and Ribbon sealer, respectively.

47. • AH Plus has thinner film thickness, decreased solubility, and is less cytotoxic than AH
26.
• Commercially available as:
• TopSeal in Europe, Central America, and South America.
• Adseal (Meta Biomed, Cheongju, Republic of Korea)
• Acroseal (Septodont, Saint-Maur-des-Fossés, France)
• MM seal (Micro-Mega, Besançon, France)

48. • AH Plus is a two paste system, delivered in two tubes and a new double barrel
syringe.
• Working time - 4 hours,
• Setting time - 8 hours
• Film thickness - 26mm.
• It is thixotropic, radio opaque and has flow of 36 mm which perfectly meets
the requirements of the ANSI/ADA (2000) standardization.
• It is characterized by very low shrinkage and by high dimensional stability.

50. • Due to its excellent properties, such as low solubility, small expansion,
adhesion to dentin and very good sealing ability, AH Plus is considered as a
“Gold Standard” sealer.
• Acroseal is also an epoxy resin based sealer containing 28% calcium
hydroxide in its composition.
• It has shown to have antimicrobial activity against Enterococcus faecalis,
low toxicity and adequate film thickness.

51. THE MONOBLOCK EFFECT
• Kittur et all stated in review article ‘ The monoblock concept in endodontics’ The
Modulus of elasticity and sealing ability are the two controversies associated with the
monoblocks which do not contribute for the root fortification. Despite several draw
backs in the theory it is said that the future of endodontics should focus on developing
newer materials to attain a leak free hermetic sealing interface between the root canal
wall and the obturating materials fulfilling the criterias required for the concept of
monoblock.
• An ideal obturation material creating a monoblock should be nonmutagenic,
noncarcinogenic , nonirritating and biocompatible to periradicular tissues. An in vivo
study on guinea pigs was performed to check the biocompatibility of primary monoblock
(MTA), secondary monoblock (resilon) and tertiary monoblock (endorez). A cytotoxicity
evaluation revealed better biocompatibility and more viable cell count and moderate to
severe levels of inflammation were seen with the three monoblocks tested.

52. HYDRATION
1. Tricalcium silicate-based (MTA/bioceramic) sealers
• MTA is a ceramic cement, introduced by Torabinejad and White in
the 1990s, based on the hydraulic powders of tricalcium silicate and
dicalcium silicate.
• Calcium silicate cements and calcium hydroxide are bioactive; that is
both ceramics release calcium and hydroxide ions.
• The ions induce the formation of hydroxyapatite on their surface
when body fluids (or synthetic body fluids) are present.

53. • ProRoot MTA Gray (Dentsply Sirona, Johnson City, TN, USA)
was the original MTA product, marketed in since 1997, but it
was only used as a root-end filling material or perforation fill,
not as a sealer.
• Bismuth oxide, zirconia, tantalum oxide, barium zirconate
have been used for radiopacity.
• Uses: perforation repair, retrograde root canal filling after an
apicoectomy, pulp capping, and pulpotomies.
• Advantages: sealing by HA formation and biocompatibility.

54. – Bioceramic based sealers include alumina, zirconia, bioactive glass, glass
ceramics, hydroxyapatite, and calcium phosphates.
– They are categorized into two groups of calcium silicate based sealers
(Mineral Trioxide Aggregate based and non MTA based) and calcium
phosphate based sealers.
– Also, another categorization of bioceramic based sealers is available in two
groups of bioactive and bioinert materials due to their interaction with the
close, alive tissues.
– Bioactive materials, such as glass and calcium phosphate, interact with the
surrounding tissue to encourage the growth of more durable tissues.

55. • When mixed with water, tri and dicalcium silicate powders react
and form a hydrated matrix with embedded calcium hydroxide.
• The calcium and hydroxide ions continue to release for about
one month after setting.
• The high pH causes the phosphate ions in body fluids to
precipitate hydroxyapatite at the surface.
• The tricalcium silicate materials are distinguished by their
bioactivity; that is, their ability to form hydroxyapatite on their
surface and an osteogenic effect.

56. • While ProRoot MTA is not suitable as an endodontic
sealer, Grey & NeoMTA Plus (NuSmile Avalon
Biomed, Houston, TX, USA) are indicated for sealing.
• Three tricalcium silicate powder- liquid systems are
known: NeoMTA Plus, BioRoot RCS, and Endo CPM.

58. • 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.
• Commercially available as:
• iRoot SP (Innovative Bioceramix, Vancouver, Canada),
• EndoSequence BC (Brasseler, Savannah, GA, USA),
• Total Fill BC (FKG Dentaire, La Chaux-de-Fonds,
Switzerland), and
• Edge Endo Sealer (Edge Endo, Albuquerque, NM, USA.

59. • EndoSequence BC Sealer is used with a single-cone
technique, a viable option for obturation in NSRCT.
• Other single-paste sealers containing tricalcium
silicate and organic liquids are:
• CeraSeal (Meta Biomed),
• Endoseal MTA (Maruchi, Gangwon-do, Republic
of Korea), and
• Bio-C Sealer (Angelus).
– They are easy to use, despite their high cost.

60. Polymer Formation By Radical
Polymerization
1. Methacrylate resin-based sealers
• The first generation began with Hydron (Hydron Technologies, St.
Petersburg, FL, USA),.
• Wichterle and Lim, contact lens researchers, developed Hydron in the
1960. It was composed of 2-hydroxyethyl methacrylate polymer gel for
injection in the canal without the need for a core, such as gutta-percha.
• However, because of its short working time, very low radiopacity,
difficulty in removal from canals, and tendency to irritate the periapical
tissues, it was discontinued in the 1980s.

61. • At the beginning of the 21st century, the desire for bonding
between dentin and sealing materials gave way to the second
generation of methacrylate sealers.
• EndoREZ (Ultradent, South Jordan, UT, USA) is a dual cure sealer
that does not require a dentin adhesive.
• Methacrylate resin was used without gutta percha to create a
“monoseal”; that is, a sealer which binds to radicular dentin as well
as the core obturation materials.
• A monoseal is achieved when the material creates a gapless
interface between the dentinal wall and rigid core (also called a
monoblock).

62. • Third-generation methacrylate-based sealers made use of formulations containing
self-etching primers, beginning with Resilon/Epiphany (Resilon Research, Madison,
CT, USA); functionally, this addition is analogous to the “all-in-one” adhesives used
in restorative dentistry.
• The Resilon/Epiphany system was an alternative to conventional gutta-
percha/sealer system.
• The Epiphany primer etched and conditioned the dentinal surface of the canal by
demineralizing it and exposing the collagen matrix.

63. • The contents of the primer allowed the Epiphany sealer
to bond covalently to the dentinal surface during
polymerization.
• The sealer also covalently bonded to the Resilon cone,
thereby achieving the monoseal desired with
methacrylate-based systems.
• The Resilon cones contained bioactive glass, which
could be resorbed. Because the dentinal wall, sealer
and cone are covalently bonded, they form a single
unit, known as a monoblock.

64. – RealSeal SE (Kerr) was a commercial product similar to
Epiphany but with less etching ability than RealSeal.
– These systems are no longer sold because they were
susceptible to degradation of their ester bonds.
• Fourth-generation methacrylate-based sealers include a
combination of self-activating etchant, primer, and sealer.
• Hybrid Root SEAL (Sun Medical, Shiga, Japan), also
commercialized as MetaSEAL (Parkell, Edgewood, NY, USA)
in the United States, is the first commercially available
sealers of this generation.

65. • Hybrid Root SEAL hybridized dentin is more resistant to low pH, which
was most effective after EDTA irrigation and may reduce microleakage.
• Super-Bond RC Sealer (Accel) (Sun Medical) is a commercially available
methyl methacrylate-tributyl borane (MMA-TBB) resin sealer which uses
TBB as an initiator and to induce interfacial polymerization of MMA at the
dentin interface.
• TBB has been shown to cause graft polymerization of MMA onto dentin
collagen, creating a collagen-MMA graft polymer.

66. • Syudo and Hayashi in 2010 introduced a “floating with accessory point technique”
using Super-Bond RC Sealer (Accel).
• The benefit of “floating” assures interfacial adhesion between dentin and the
sealer for hermetic sealing.
• After placement of a floating master cone gutta-percha point, accessory points
may be inserted to reduce voids/bubbles and increase interfacial contact for
adhesion.
• They also noticed the mixed layer of the resin and gutta-percha at the interface of
the canal walls, sealer, and gutta-percha bonded, creating monoblock.

67. • Simultaneous treatment for root canal filling and core construction (STRC), a
technique developed by Masaka et al., uses MMA-TBB resin to adhere a fiber
post system.
• The fiber post has an elastic modulus similar to dentin, unlike metal posts,
making to more suitable for mimicking masticatory stress and strain.
• STRC uses the fiber post system replacing gutta-percha points with a minimum
condensing force during the root canal obturation process.
• STRC is beneficial because it minimizes the number of patient clinical visits and
may prevent vertical root fractures as a result of monoblock formation.

68. ANTIBACTERIAL METHACRYLATE RESIN-BASED
– A different approach was adopted in third generation MRB sealers by
incorporating sustained antibacterial activity into the polymerized sealer. (Dr
Satoshi Imazato, personal communication, July 2008).
– Both the primer and sealing resin contain the antibacterial resin monomer 12-
methacryloyloxydodecyl pyridinium bromide (MDPB).
– Chlorhexidine releasing PMMA based sealers have been developed with the
incorporation of 2-3 wt% CHX diacetate into the sealer powder.

69. CALCIUM PHOSPHATE-BASED SEALERS
– It is well known that calcium phosphate cement has a high biocompatibility
because of its composition, almost identical to that of tooth and bone
mineral.
– This makes the material useful when the cement is in contact with the vital
tissues. Therefore, it has been suggested for endodontic therapy as root
canal sealer.
– Eg:Capseal I, Bioseal, Apatite Root sealer (I, II, and III), Capseal II

70. – Apatite root canal sealer is composed of hydroxyapatite and tricalcium
phosphate and is available in 3 types based on difference in composition and
use.
– Bioseal (Ogna Lab Farma, Italy) is hydroxyapatite containing eugenol sealer.
These sealers have favorable tissue responses, acceptable biocompatibility and
good sealing abilities.
– Bae et al. reported that Capseal I and II have superior mineralization potential
than other commercial root canal sealers.
– Capseal I and II produced pH and calcium ion release higher than or equal to
those of Sealapex and Apatite root sealer.

71. LITERATURE REVIEW ON
PROPERTIES OF SEALERS

72. 1. SETTING TIME & SOLUBILITY
• Setting time and solubility are critical components in the sealing ability
of sealers.
• Slow setting times allow for sealer to more readily penetrate intricate
canal morphology even after treatment.
• Faster setting times may be indicated in time sensitive situations, such as
when obturation must be completed quickly or a post must be placed
sooner.

73. SEALERS SETTING TIME SOLUBILITY
ZOE BASED Proco-Sol - 40.5 min to 42 h,
Tubli-Seal – 1hr.
3% solubility of sealers in distilled
water, 5.19% in halothane
IONOMER BASED Ketac Endo – 2.5 hrs 1.6% solubility in water with weight
loss of less than 1%
exposed for 10 min
SILICONE BASED GuttaFlow - 17.4 min 0.13% solubility in water
TRICALCIUM SILICATE
BASED
EndoSequence BC - 1month
BioRoot RCS - 4hrs
Bio-C - 3hrs
CeraSeal - 3.5hrs
BioRoot RCS and Total Fill BC sealer
- higher solubility in distilled water

74. SEALERS SETTING TIME SOLUBILITY
EPOXY RESIN BASED AH 26 – 34 hrs
AH Plus – 8hrs
AH PLUS - 0.16% solubility in water
more soluble in halothane, yielding
68% weight losses
METHACRYLATE
BASED
Super-Bond RC Sealer (Accel) – 42
mins
EndoREZ and Epiphany, were shown
to have 3.5–4% solubility in water,
SALICYLATE-BASED Sealapex – 58 mins Sealapex met the solubility
requirements.
Apexit solubility in halothane was
similar to ZOE sealers

76. – In summary, setting times for most sealer types were acceptable
and well above one hour, with an exception of silicone-based
sealers, which had markedly shorter setting times.
– Solubility depends on the sealer matrix chemistry.
– For re-treatment, mechanical removal of a sealer will be useful for
tricalcium silicate-based sealers and resin-based sealers.

77. 2. SEALING ABILITY
– Sealing ability is of utmost importance for a sealer. Although many microleakage
studies have been published, direct comparison of each sealer is difficult because
experimental condition was different in each experiment/research.
– In many papers each sealer was tested together with AH Plus. Thus it will be
convenient to compare sealing ability of each sealer by using AH Plus as a
standard.
– The relative degree of microleakage was calculated by length of microleakage of
each sealer divided by that of AH Plus.

79. 3. ANTIMICROBIAL ACTIVITY
– Antimicrobial activity can be directly caused by a sealer, or indirectly by entombing
bacteria.
– Any endodontic sealer that does make a hermetic seal functions to entomb bacteria
within the canal and tubules, preventing communication of residual bacteria to the apical
tissue.
– However, bacteria present at the apex may not be entombed, and would be killed by an
antimicrobial endodontic sealer.
– Zinc oxide is a well-documented antimicrobial material because it forms a reactive
oxygen species and interferes with bacterial membrane proteins.

80. SEALER ANTIMICROBIAL ACTIVITY ORGANISMS
ZOE sealers Better compared to epoxy resin
sealers
Streptococcus mutans,
Staphylococcus aureus, and
Enterococcus faecalis
Glass ionomer sealers Minimal activity inspite of
fluoride release.
Silicone-based sealers No antimicrobial activity
Gutta Flow and Roekoseal
Streptococcus mutans,
Staphylococcus aureus,
Staphylococcus epidermidis,
and Enterococcus faecalis - X
MTA based sealers Antimicrobial effect
MTA and Portland cement =
ZOE, salicylate (sealapex) and
epoxy resin sealers (AH Plus)
Facultative bacteria
Obligate anaerobes - X
Staphylococcus aureus,
Enterococcus faecalis, Candida
albicans. - X

81. SEALER ANTIMICROBIAL ACTIVITY ORGANISMS
Tricalcium silicate-based • Endo Sequence BC Sealer > ZOE and
epoxy resin sealers
• They increase the local pH by release of
calcium and hydroxide ions.
• Total Fill BC Sealer
• EndoSequence BC Sealer and ProRoot
MTA > epoxy resin (AH Plus) and ZOE
sealers
Enterococcus faecalis
effect on planktonic bacteria
biofilms for Staphylococcus
aureus and Enterococcus
faecalis.
Enterococcus faecalis
Epoxy Resin Sealers • AH Plus sealer > GuttaFlow
• AH Plus < MTA Fillapex (salicylate-
based sealer) and CRCS (ZOE sealer).
• Zone of inhibition tests for AH Plus
were comparable to ZOE sealers.
• AH Plus had the highest antibacterial
however lasting only for 24hrs.
planktonic and biofilm bacteria

82. SEALER ANTIMICROBIAL ACTIVITY ORGANISMS
Methacrylate resin-
based sealer
• Endo REZ had the strongest
activity compared to AH Plus and
Sealapex
Calcium hydroxide-
containing sealers
• CRCS > epoxy resin (AH Plus) and
MTA sealers
• Calcium-hydroxide based sealers
> zone of inhibition than ZOE
sealers
• Supercal (Ozdent, Sydney,
Australia) > MTA and AH Plus
sealers.
Enterococcus faecalis

84. 4. BIOCOMPATIBILITY AND
CYTOTOXICITY

85. SEALER BIOCOMPATIBILITY CYTOTOXICITY
ZOE sealers • Irritant - They activated a
complement mediated immune
response
• Non eugenol sealers - Canals-
N29 and Nogenol were later
introduced
• Cytotoxic - fibroblast cytotoxicity.
Glass ionomer
sealers
• Caused inflammation when
implanted subcutaneously into
rats, although it was not
detectable after 3 months.
• (Fuji II, GC) had lower
cytotoxicity when freshly mixed
compared with resin (Chem-fil
II, De Trey, Wiesbaden, West
Germany).
• Fully set, GIC > Chem-fil II after
setting, because of its fluoride ion
release.
• low level of cytotoxicity over long
periods of time, indicating they
consist of very biocompatible
material

86. SEALER BIOCOMPATIBILITY CYTOTOXICITY
Tricalcium silicate-
based
• EndoSequence BC Sealer have
strong cell viability even
decreasing LPS mediated
inflammation.
• Osteoinductive properties and
cytocompatibility: BioRoot RCS >
Pulp Canal Sealer.
• BioRoot RCS and EndoSequence BC
Sealer showed no cytotoxic effects on
human bone marrow mesenchymal
cells when compared to AH Plus
• Over 6 weeks, EndoSequence BC > AH
Plus to osteoblast progenitors
• MTA was found to be cytotoxic in vivo
in rats, two and seven weeks
Silicone-based sealers • Gutta Flow was determined to be
biocompatible in a fibroblast
incubation test.
• Less cytotoxic < Epoxy resin based (AH
26 and AH Plus) during the first 11
days of fibroblast suspension cultures,
and similar cytotoxicity was measured
after 24 hrs.

87. SEALER BIOCOMPATIBILITY CYTOTOXICITY
Epoxy Resin
sealers
• Limited
biocompatibility
• High levels of
inflammation have
also been detected
in periapical and
subcutaneous
tissues
• Unset epoxy sealers are genotoxic in
mammalian cell mutation assays,
attributed to residual monomer and
formaldehyde.
• Set sealers- no genotoxic activity after
24 h.
• AH 26 release formaldehyde even two
days after being mixed.
• AH Plus is modified such that
formaldehyde is not released.

88. SEALER CYTOTOXICITY
Methacrylate based
sealers
• negligible - set, cytotoxicity - early in the setting process.
• Incompletely cured MMA - cytotoxic.
• TEGDMA, UDMA, HEMA and PEGDMA - time-dependent increases in cell
death.
• EndoREZ > epoxy resin-based sealer (AH Plus) and a silicone-based sealer
(RoekoSeal)
• Real Seal and EndoREZ > salicylate-based (Apexit Plus) or epoxy resin-
based sealer (AH Plus).
• However, in comparison with their epoxy resin-based counterparts (AH
Plus), methacrylate-based sealers (Hybrid Root SEAL/ MetaSEAL and Super-
Bond RC Sealer (Accel)) are less cytotoxic in plated cultures.

89. Poor biocompatibility - ZOE sealers
Moderate biocompatibility - methacrylate-based systems, glass ionomer
sealers, and salicylate-based sealers.
Superior biocompatibility - silicone-based sealers and tricalcium silicate-
based sealers.
AH Plus > AH 26 in epoxy resin sealers. (Biocompatibility)
In epoxy resin and methacrylate resin sealers, unset sealer < set sealer.
Better biocompatibility MMA - TBB resin > other resin sealers.

92. 5. BOND STRENGTH

94. REFERRED ARTICLES
AND COMPARISON

104. SEALER PLACEMENT

109. CLINICAL
IMPLICATION
AND FUTURE
DIRECTIONS

110. • Pulp diagnosis as vital or necrotic is important for selection of an endodontic
sealer for clinical use.
• In vital pulp (pulpitis) cases, the therapeutic effects of sealers are not
necessary under the asepsis technique NSRCT, based on study by Kakehashi et
al.
• Therefore, sealers which have shown effective sealing, are a good choice.
• While tricalcium silicate sealers show the least leakage, they have slow setting
times.
• Therefore, tricalcium silicate sealers are not a good choice if post/core/build-
up must occur on the same day together with endodontic obturation.

111. • In necrotic pulp cases, especially cases with large apical radiolucency, the
therapeutic effects of tricalcium silicate-based sealers are useful.
• A medicated sealer to kill bacteria should increase the chances of long-term
success.
• Salicylate-based (calcium-hydroxide-containing) are good choices if
post/core/build-up is performed immediately after completion of endodontic
obturation.
• A clinician has the responsibility to decide the top priority for the patient: good
sealing or a therapeutic effect.

112. CONCLUSION
• In future, the importance of sealers will become more of a focus in clinical treatment.
Clinicians will better understand the sealer’s role in preventing bacterial leakage, resulting
in a successful outcome in endodontic practice.
• Compared to AH Plus, tricalcium silicate sealers showed the lowest relative microleakage
among the sealers assessed, followed by silicone sealers and other non-AH Plus epoxy
resin sealers.
• Tricalcium silicate sealers also exhibit the most favorable antimicrobial effect and
excellent biocompatibility.
• Future sealers developed should ideally combine a hermetic seal with therapeutic effects.

113. REFERENCES
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based endodontic sealers comparable to conventional materials? A systematic review
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J. Craig Baumgartner. Hamilton, Ont.: BC Decker; 2008.
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