bioceramic sealers in restorative dentistry

bioceramic sealers in restorative dentistry

1. Bioceramic sealers

2. Introduction Bioceramic materials C lassification 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:

3. 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 .

4. Classification:

5. 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???

6. 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

7. 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

8. 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.

9. Bioceramic sealers

10. 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.

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

12. Mechanism of bonding

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

14. 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

15. 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:

16. 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

17. 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

18. Retreatability : EndoSequence BC Sealer is difficult to remove from the root canal using conventional retreatment techniques , including heat, chloroform, rotary instruments, and hand files. B ut, 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 %.

19. 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

20. Antimicrobial Properties: H igh ph. T wo additional mechanisms associated with the antibacterial efficacy of iRoot SP: hydrophilicity and active calcium hydroxide diffusion.

21. Adhesion and strengthening of root: monoblock effect

22. 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:

23. 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:

24. 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.