Root Filling Material: RealSeal (Resilon).ppt

Use of Real Seal for root canal obturation

2. Root Filling Material:
RealSeal (Resilon)

3. A thermoplastic synthetic polymer-
based root filling material to
replace gutta-percha

4. BONDS WITH REALSEAL SEALER WHICH BONDS TO
THE CANAL WALL, CREATING A SEAMLESS SEAL
AND ROOT STRENGTHENING.
WHAT IS RESILON
®
?
BASED ON POLYMERS OF POLYESTER
RESILON CONTAINS: BIOACTIVE GLASS,
CA(OH)2, AND RADIOPAQUE FILLER

5. “State of the art”
Gutta-percha
•Entomb existing bacteria
•Prevent coronal leakage
•Strengthen the root

6. Radiopacity

7. ACID
Smear Layer
Demineralized Dentin
Exposed Collagen
1
2
P
I
C
Acid-Etching
Dentinal tubules after shaping with files, smear layer removal, (smear clear)
exposes collagen and demineralizes dentin which allows the bond between
the real seal to bond to the dental structure.

8. Smear Layer SmearCleared
Photography courtesy of: Jantarat J., Yanpiset K., Harnirattisai C..

12. Factors Influencing Radiographic Periapical Status of
Endodontically Treated Teeth
CategoryNumber % of Total% Success% Failure
Good Endo
& Resto
330.5 32.7 91.4 8.6
Poor Endo
& Resto
213 21.1 18.1 81.9
Good Endo
Poor Resto
164.5 16.2 55.9
Poor Endo
Good
Resto
302 30.0 30.4
44.1
69.6

13. DR MARTIN TROPE
RealSeal & Resilon work together to give you a ‘restoration-like’ seal
from crown to apex – unrestored cases obturated with RealSeal &
Resilon

14. October 05Sept 05 Sept 08
Tooth fractured in 05
Dr Martin Trope

15. April 04 April 04 November 08
Temporary in place for 4 years, Tooth broke 1 year previously
Dr Martin Trope

16. November 03 April 07
Temporary for 3.5 years, unknown when tooth fractured
Dr Martin Trope

17. February 05 January 07
Fractured “almost immediately after RCT”
Dr Martin Trope

18. Primer
Bonding Resin
43
C
Resin Penetration
Primer and Sealer bonding together in dentinal tubules

19. RealSeal sealer tagsRealSeal sealer tagsRealSeal sealer tags

20. Dentin
Gutta-percha + AH26
Dentin

21. Gutta-percha + AH26
Dentin
Gutta-percha + AH26
AH26

22. Dentin
(RealSeal) Filler and Sealer ‘monoblock’

23. Dentin
(RealSeal) Filler and Sealer ‘monoblock’

24. Non-toxicNon-toxic
Non-mutagenicNon-mutagenic
Significantly less leakage than gutta-perchaSignificantly less leakage than gutta-percha
Increased fracture resistanceIncreased fracture resistance
RetreatableRetreatable
RealSeal

25. Warm Vertical
Obturation
Dr. Martin Trope and Dr. Fred Barnett

26. •Choose a standardized ISO Sized
point with the appropriate taper.
•Obtain “tugback”, and the
remove .5mm of the apical
portion of the point.

27. •Insert the narrow posterior heat
carrier (.5mm tip) from your warm
obturation unit.
•Pre-fit it to its binding point and
adjust the rubber stopper to this
point.

28. •The RealSeal primer and or
RealSeal sealer is placed in the
canal.
•The apical 4 mm of the master
cone is buttered lightly with
RealSeal sealer and using gentle
pressure, the cone is seated to
place.

29. •The heat carrier is driven
through the center of the
RealSeal cone in a single
motion to a point 3 to 4 mm
shy of its apical binding point.

30. •While maintaining pressure on
the heat carrier, the ring switch
is released and the heat carrier
slows its apical movement as
the carrier tip cools and
approaches the apical binding
point.

31. •Pressure is sustained on the
carrier for five seconds to
minimize shrinkage on cooling.

32. •The omni-directional ring
switch is activated again for a
separation heat burst.

33. •The heat carrier is removed and
the surplus RealSeal material will
come out with it leaving a clean
canal space.
•A quick separation burst of heat is
advisable in order to prevent
reheating the apical mass.

34. •In ovoid or canals that join in the middle or apical
thirds, a secondary RealSeal cone is placed against
the master cone short of the canal terminus and
wedged to place with a finger plugger or spreader to
avoid venting of surplus RealSeal during the heat
carrier downstroke.

35. •RealSeal sealer is applied to the
walls of the canal before beginning
to backfill.
•The applicator tip of the Obtura
II™ thermoplasticized delivery
system is inserted into the coronal
aspect of the apical plug.
•It is allowed to warm the RealSeal
and a 4 mm increment is delivered.

36. •Prefit Schilder or Buchanan
pluggers are now used to
condense the thermosoftened
RealSeal.
•Slow measured delivery
ensures the densest mass of
material.

37. •The condensing cycle begins
with the smaller plugger and
the increase in size with the
application of each increment.

38. •The entire canal space should
be sealed initially regardless of
whether or not a post is
planned.
•Lateral canals are present
throughout the furcation and
interfurcal region of all multi-
rooted teeth.

39. It is recommended that the RealSeal sealer be
light-cured for 40 seconds & in all multi-rooted
teeth that the floor of the chamber space be
sealed with a combination of dentin adhesive,
flowable composite and GIC material.

40. Real Seal with Resilon
12-9-03
7-15-04
Joseph D
Maggio
Temp out 4+ months
Note: healing without coronal restoration
– RealSeal truly seals the canal

42. Dr. Fred Barnett
(RealSeal) Cases; PacMac @20,000 RPM

43. Dr. Fred Barnett
(RealSeal) Cases; PacMac @20,000 RPM

44. Dr. Fred Barnett
(RealSeal) Cases; PacMac @20,000 RPM

45. Dr. W. Watson Jr.

46. Dr. Fred Barnett

49. Non-toxicNon-toxic
Non-mutagenicNon-mutagenic
Significantly less leakage than gutta-perchaSignificantly less leakage than gutta-percha
Increased fracture resistanceIncreased fracture resistance
RetreatableRetreatable
No Primer Needed!No Primer Needed!

50. Feature Benefit
Self-Priming Time Saving
Less Technique
Sensitive
Short Learning Curve
Easy transition from
other brands &
techniques

51. Root Canal Dentin

52. Root Canal
Dentin

53. RealSeal Filler
RealSeal SE
Sealer
Dentin

55. RealSeal 1
Bonded Obturator

56. 17 mm
20 mm
22 mm
24 mm
18 mm
•Each stripe is 1mm wide
•Each gap is 1mm wide
•Stripes are very visible
•No stop =
•Better visibility for insertion into canal
•Clear shot for light curing sealer
No Need For Stops

57. Feature
•Resilon adheres to the core
•Sealer adheres to the core
•Resilon bonds to the RealSeal sealer
•RealSeal sealer bonds to the dentin
•Obturators are injection molded
•Core has contrasting radiopacity
•Readily retreatable
•Same technique as ‘carrier-based’ systems
RealSeal 1
Bonded Obturator

58. The RealSeal 1 Technique

59. Make sure you have an adequate access opening to
facilitate obturation
.08
Correct Incorrect
Step One

60. Step Two
Insert verifier to identify accurate apical canal size. It is essential that the size verifier fits loosely in the canal.
If the verifier sits too snug, go one size smaller.
Correct Incorrect

61. Step Three
Put in RealSeal Self Etch Sealer but do not flood the canal.
Correct Incorrect

62. Step Five
Insert the Bonded Obturator into the root canal. It is very important that the
Obturator be placed in the canal within 6-10 seconds of removing it from the oven.
Correct
<10 Sec
Incorrect
>10 Sec

63. Step Six
For short canals you may want to cut off approx 2mm of Resilon
material from the coronal portion of the obturator.
2 mm
Before After

64. RealSeal 1
Bonded Obturator
Dipped (Thermafil) vs Molded, Quality You Can See…

65. Thermafil
Gaps between
carrier/Gutta Percha
Between GP/Sealer
and canal wall
Stripped carrier against
canal wall with gap.
Carrier
•No bonding capable
•Multiple entryways for leakage

66. RealSeal 1
Resilon
Canal Wall
Core
RealSeal SE
sealer
•Complete bonding
•No entryways for leakage

67. Thermafil
No bond
Carrier
Gutta
Percha
•No bonding evident
•Leakage possible between GP and carrier

68. RealSeal 1 Bonded Obturator
Gapless
Core
Resilon
•Complete bonding between core and Resilon
•No entryways for leakage

69. Core
Carrier
Gutta Percha
Resilon
Gapless Interface
Gap InterfaceThermafil
RealSeal 1
Bonded
Obturator
T. Malmsten, R. Yapp, J.M. Powers, unpublished report to SybronEndo, May 2009

70. Core
RealSeal 1
Bonded Obturator
All together now!
RealSeal sealer dentin
Resilon RealSeal sealer dentin

71. Thermafil
1mm from apex
• No bonding
• Multiple entryways for leakage
Sealer?
Carrier

72. RealSeal 1 Bonded Obturator
1mm from apex
•Bonding (in apical 3
rd
!)
•No entryways for leakage
Resilon
Dentin
Sealer

73. Benefit
•Less difficult to remove
–Fewer unhappy specialists
–Peace of mind for the GP
–Easier on the patient
RealSeal 1
Bonded Obturator
Readily retreatable

74. Thermafil

75. RealSeal 1
Bonded Obturator

76. RealSeal 1
Bonded Obturator

77. RealSeal 1
Competitive Summary
RealSeal 1 Tulsa (95% of
Market)
Filler/Core Adhesion

Oven

Sealer/Filler/Dentin
Bond

Injection Molded

Price

Contrasting
Radiopacity

Sealer/Core Adhesion

Readily Retreatable

Variety


78. Results: Histologic evidence of
periapical inflammation was
observed in 29% of the Thermafil
group and in 9%of the RS-1 group.
Histologic evidence of bacterial
penetration was present in 9% of
the RS-1 group and in 70% of the
Thermafil group.
Conclusions: RS-1
appeared to resist bacterial
penetration more
effectively
than Thermafil under the
conditions of this study.
(J Endod 2009;35:852–857)
Newest Research

79. BENEFIT: Reduces gaps and chance
for leakage
Microleakage study, Dr Gianluca Gambarini
University of Rome

80. ,014 ,019 ,003 58 0,000 ,089 0
,003 ,005 ,001 24 0,000 ,022 0
,018 ,013 ,003 20 0,000 ,035 0
,029 ,029 ,008 14 0,000 ,089 0
MeanStd. Dev.Std. ErrorCountMinimum Maximum # Missing
Microliter/Min, Total
Microliter/Min, Exp_Group
Microliter/Min, onestep
Microliter/Min, thermafill
Descriptive Statistics
Split By: Groups

81. 0
,005
,01
,015
,02
,025
,03
,035
,04
C
e
ll M
e
a
n
Microliter/Min
thermafill
onestep
Exp_Group
Cell Bar Chart
Split By: Groups
Error Bars: ± 1 Standard Error(s)

82. 2 ,006 ,00312,123 <,000124,246 ,997
55 ,014 2,632E-4
DFSum of Squares Mean Square F-ValueP-ValueLambdaPower
Groups
Residual
ANOVA Table for Microliter/Min
-,015 ,010 ,0028S
-,026 ,011<,0001S
-,011 ,011 ,0684
Mean Diff.Crit. DiffP-Value
Exp_Group, onestep
Exp_Group, thermafill
onestep, thermafill
Fisher's PLSD for Microliter/Min
Effect: Groups
Significance Level: 5 %

83. 1
0
Pie Chart for Infiltr_Par
Split By: Groups
Cell: Exp_Group
1
0
Pie Chart for Infiltr_Par
Split By: Groups
Cell: onestep
1
0
Pie Chart for Infiltr_Par
Split By: Groups
Cell: thermafill
10
17,241
8
33,333
1
5,000
1
7,143
48
82,759
16
66,667
19
95,000
13
92,857
58
100,000
24
100,000
20
100,000
14
100,000
Total Count
Total Percent
Exp_Group Count
Exp_Group Percent
onestep Count
onestep Percent
thermafill Count
thermafill Percent
0 1 Total
Frequency Distribution for Infiltr_Par
Split By: Groups

84. Leakage Test
RealSeal 1 vs Thermafil/Softcore
Dr. Stephen Davis
VA Hospital, Long Beach, CA

85. microL/min (cumulative avg.)
Water Leakage
Mean Water Leakage

86. microL/min (cumulative avg.)
Mean Water Leakage
230% greater than RS1
203% greater than RS1

87. 0
,005
,01
,015
,02
,025
,03
,035
,04
C
e
ll M
e
a
n
Microliter/Min
thermafill
onestep
Exp_Group
Cell Bar Chart
Split By: Groups
Error Bars: ± 1 Standard Error(s)
967% higher than RS1
600% higher than RS1
Dr Gianluca Gambarini Results

88. Results
•Dr Davis results support Dr Gambarini results
•Dr G results are more dramatic
–Almost double pressure used in G experiment
–Both experiments used pressures much higher than those in the oral cavity

89. April 4, 2008

Pentron Technologies

Re: Resilon-based carrier root filling system

We have completed our in-vtiro retreatment study on the Resilon-based carrier system:

Protocol: Fifty-two extracted human teeth with single canals and curvature less than 20 degrees were
used for this study. The teeth were decoronated at the CEJ perpendicular to the long axis of the root, so
that each root was approximately 12 mm in length.

Instrumentation: The working length of each canal was established with a #15 K-file 0.5 mm short of the
visible apical foramen. The canals were instrumented using a crown-down technique with Profile or K3
NiTi rotary instruments. Fianl apical file size was ISO #40/.04 for all canals. Instrumentation was carried
out under copious irrigation with 6% NaOCl. The smear layer was removed by irrigating the canals with 5
ml of 17% EDTA, followed by 5 ml of 6% NaOCl; a final rinse of 5 ml of sterile water was used. The
canals were then dried with sterile paper points.
The teeth were randomly divided into two groups of 26 teeth each to receive either the Resilon Obturator
or Thermafil obturator, as the root filling material. All root fillings were performed according to
manufacturers instructions. Each canal orifice was then surface-sealed with 2 mm of an etched and bonded
composite resin material. Specimens were stored at 37°C in 100% humidity for 2-3 wk to allow for
completed setting of all materials.
Retreatment: All roots had 3 mm of filling material removed from around the carriers using a SystemB
device to create a reservoir for chloroform solvent. 0.2-ml chloroform was introduced in each canal to
soften the filling material. Increments of 0.05ml of chloroform were placed into each canal to facilitate the
removal root filling material.
During the retreatment, root canals will be constantly irrigated with 6% NaOCl. In all cases, the canals
were instrumented to two sizes larger than the original master apical file used; size #50/.04. The criteria
for completion of retreatment was the removal of the carrier and root filling material, as verified by
radiographs. If these requirements are not met, the canals will be further instrumented with files until the
criteria are fulfilled. After final instrumentation, all canals will be irrigated with 5.0 ml of 6% NaOCl and
dried with paper points. The duration of retreatment was recorded to the nearest second with a stopwatch.
Results:
Average time to retreat Thermafill obturators: 7.76 minutes.
Average time to retreat Resilon obturators: 6.23 minutes.


Frederic Barnett, DMD
Chairman and Program Director
IB Bender Division of Endodontics
Department of Dental Medicine

90. Thermafil Carrier 15 minutes – No Change
Cores in Chloroform with agitation
(From Fred Barnett)
RealSeal 1 – 3 minutes
Completely dissolved

91. Thermafil
Gutta Percha Crumbles
Flash
Core not centered

92. Molded Obturator – no flash
core centered-
Resilon will not crumble
nor strip

93. Confocal Microscope Images
RealSeal penetration in
tubules
Dr Ronald Ordinola Zapata
Brazil

94. RealSeal penetration in
tubules – higher mags
Bifurcated Tubules Filled With RealSeal
Dr Ronald Ordinola Zapata
Brazil

95. Previous experiences - problems
Lateral compaction -Sealapex
void
Excess of sealer in the root canal
Penetration is not
Constant, here we
don´t have any
penetration
void
Irregular canals are not
Well filled
Penetration is not
Constant, here we
don´t have any
penetration
Dr Ronald Ordinola Zapata
Brazil

96. void
Single Cone or Lateral Condensation
Dr Ronald Ordinola Zapata
Brazil

97. Lateral compaction -Sealapex
Lateral compaction –sealer26
Dr Ronald Ordinola Zapata
Brazil

98. Poor fillings in irregular
canals
Dr Ronald Ordinola Zapata
Brazil

99. artifact
No voids
RealSeal 1
Dr Ronald Ordinola Zapata
Brazil

100. RealSeal 1
Dr Ronald Ordinola Zapata
Brazil

101. Good flow of Resilon
Dr Ronald Ordinola Zapata
Brazil

102. RealSeal 1
Dr Ronald Ordinola Zapata
Brazil

103. Thermafil
Dr Ronald Ordinola Zapata
Brazil

104. FEATURE: Resilon-based Sealer, Resilon and
Core bond together
Dentin
(Section 3mm from apex)
Core
Resilon
RealSeal SE sealer

105. RealSeal 1
Resilon
Canal Wall
Core
RealSeal SE
sealer

106. RealSeal 1
.04 taper RealSeal 1 Obturator
Prep: Quantec .12
TF 25/.10 to apex
TF 30/.06 Apical MAF

107. Fill at Apex
RealSeal SE Sealer

108. 2mm from apex
RealSeal SE sealer with Resilon
Sealer
Resilon

109. 6mm from apex
Sealer, Resilon, Polysulfone core
Sealer
Core
Resilon

110. 10mm from apex
Sealer
Core
Resilon

111. 12mm from apex
Sealer
Core
Resilon

112. 14mm from apex
Sealer
Core
Resilon

113. 16mm from apex
Sealer
Core
Resilon

114. Canal orifice
Sealer
Core
Resilon

115. SybronEndoSybronEndo
A few cases

116. NOAH CHIVIANNOAH CHIVIAN

117. NOAH CHIVIANNOAH CHIVIAN

118. NOAH CHIVIANNOAH CHIVIAN

119. NOAH CHIVIANNOAH CHIVIAN

120. Joseph D Maggio

121. Joseph D Maggio

122. Joseph D Maggio

123. Joseph D Maggio

124. Joseph D Maggio

125. Joseph D Maggio
9/19/08

126. Joseph D Maggio
10/17/08

127. Joseph D Maggio

128. Joseph D Maggio
Pre op 12/27/06

129. Joseph D Maggio
Post op 1/4/07

130. Joseph D Maggio
21 month
recall 9/24/08

131. Joseph D Maggio
11/6/08

132. Joseph D Maggio
11/14/08

133. Joseph D Maggio3 Month Recall 2/11/09

134. Joseph D Maggio
1/30/09

135. Joseph D Maggio
2/11/09

136. Joseph D Maggio
2/4/09

137. Joseph D Maggio
2/13/09

138. Joseph D Maggio
2/5/09

139. Joseph D Maggio2/13/09