sealers in endoodntics for root canal.pptx

root canal sealers in endodontics

1. ROOT CANAL SEALERS Dr. Mayuri Rane MDS,MBA

2. Introduction Definition Requirements of a sealer Functions Classification Various sealers Sealer extrusion Controversies conclusion

3. INTRODUCTION The success of the root canal treatment depends upon various factors. One among them is achieving a leakage free environment in the root canal space in other words to achieve a perfect seal at all the levels of root canal dentin.

4. Definition Sealers are the binding agents use to fill up the gap between the root canal walls and the obturating materials. It also fill up the irregularities, discrepancies, lateral canals and accessory canals. (Or) Root canal sealer is a radiopaque dental cement used usually in combination with a solid or semisolid core material, to fill voids and to seal root canals during obturation.

5. History 1931 – Original ZOE cement by Rickett. 1952 – Biocalex introduced by Bernard. 1955 – Scheufele introduced resin based Diaket sealer. 1956 – Grossman’s non staining ZOE formula appeared as a sealer. 1960 – Witchtelle and Lion introduced plastic material hydron. 1961 – Tubliseal was introduced with a slight modification to Ricket’s formula. 1965 – Nyborg and Tullin formula of Kloropercha . 1973 – N2 was introduced by Sargenti .

6. 1976 – Pitford recommended endodontic glass ionomer ketac -endo as a root canal sealer. 1985 – Browne developed calcium phosphate cement. 1990’s – Inorganic agents which have biocompatibility with biological tissues like the bioceramics have been developed focussed mainly on apatite type and tricalcium phosphate. 2004 – Epiphany and gutta flow

7. REQUIREMENTS OF IDEAL ROOT CANAL SEALERS Tacky when mixed to provide good adhesion between it and the canal wall when set. Hermetic seal. Radiopaque. The particles of the powder should be very fine so that they can mix easily with the liquid. Should not shrink upon setting. Should not stain the tooth structure. Bacteriostatic or atleast not encourage bacterial growth.

8. REQUIREMENTS OF IDEAL ROOT CANAL SEALERS Should set slowly. Insoluble in tissue fluids. Nonirritating to periradicular tissues. Should be soluble in common solvent if it is necessary to remove the root canal filling. Should not provoke an immune response in periradicular tissue. Should be neither mutagenic nor carcinogenic.

9. FUNCTIONS OF SEALERS Antimicrobial agent Binding agent A filler A lubricant Radiopacity As canal obturating material

10. Classification Messing Silver based Silver free Diaket resin based AH 26 Klor & Eucapercha Non Eugenol, endofil, GIC Iodoform Paste Ca (OH)2 paste

11. Eugenol a. Silver containing i . Kerrsealer (Ricket 1931) ii. Procosol radioopaque Ag cement(Grossman 1936) b. Silver free cement 1.   Procosol non staining cement (Grossman 1958) 2.   Grossman sealer (Grossman 1974) 3.   Tubliseal (Kerr, 1961) 4.   Wach’s paste ( Wach 1925)

12. ii) Non Eugenol Diaket AH-26 Chloropercha + Eucapercha Nogenol Hydron Endofil Glass ionomer Poly carboxylate CaPO 4 cements Cyanoacrylate

13. iii) Medicated Diaket – A N2 Endomethasone SPAD Iodoform paste Riebler’s paste Mynal cement Ca(OH)2 paste (Lanes 1962) Ca(OH)2 paste (Frank, 1962) ( Biocolex ) Endofloss

14. II) According to Grossman Zinc oxide cements Resin cements Calcium hydroxide cements. Paraformaldehyde cements. Pastes. III) According to Clarke Absorbable Non-absorbable IV) According to Ingle Cements Pastes Plastic

15. V) According to Harty Zinc oxide eugenol based. Tubliseal Wach’s paste. Grossman Resin cement. AH-26. Diaket . Hydron . Gutta-percha based. Chloropercha . Eucapercha .

16. Dentin adhesive materials. GIC. Cyanoacrylate . CaO 2 PO 2 Composite material. Polycarboxylate Materials to which medicaments have been added. Paraformaldehyde – calcium hydroxide. Calcibiofic (CRCS). Sealapex . Bicalex .

17. According to Stock Zinc oxide eugenol sealers Calcium hydroxide based sealers Combination of zinc oxide and calcium hydroxide material Glass ionomer sealer Resin based sealer Silicon based sealer

18. Factors to be considered in selection of sealers These are determined by the need for each case Amount of lubrication that is needed Working time anticipated Temperature of core materials Irritating potential of sealer, if it escapes into periapical tissues Choice of intra canal irrigants and medicaments Antimicrobial action Biocompatibility

19. ZINC OXIDE SEALERS

20. Kerr pulp canal sealer Based on cement described by Dixon and Ricket in 1931 Powder   Liquid   Zinc oxide 34-41.2% Oil of cloves 78-80% Precipitated silver 25-30% Canada balsam 20-22% Oleo resins 30-16%     Thymol iodide 11-12%    

21. Advantages Excellent lubricating properties. Germicidal and biocompatibility. Greater bulk than any sealer Prostaglandin inhibition property Disadvantages Stains dentinal tubules. Rapid setting time Indication Warm gutta-percha technique where lateral canals are present. PCS-EWT - setting time 6 hrs

22. Procosol radiopaque – silver cement Introduced by Grossman – 1936 Composition Powder   Liquid   Zn Oxide USP 45% Eugenol 90% Precipitated silver 17% Canada balsam 10% Hydrogenalid resin 36%     Magnesium oxide 2%     Powder   Liquid   Zno 40% Eugenol 80% Staybelite resin 27% Sweet oil of almond 20% Bismuth subcarbonate 15%     Barium sulphate 16%     Procosol non staining cement Grossman 1958

23. Grossman Sealer – ROTH’S 801 Revised in 1974 Composition Powder   Liquid   Zinc oxide 40 parts Eugenol 5 parts Staybelite resin 30 parts     Bismuth subnitrate 15 parts     Barium sulfate 15 parts     Sodium borate anhydrous 1 part    

24. Properties Plasticity and low setting time. Good sealing potential and small volumetric change on setting. Zinc eugenolate in decomposed by water through continuous loss of eugenol – thus a weak unstable compound. Setting time 2 hours at 37°C but in root canals it begins to set within 10-30 mins .

25. Disadvantage Resin is of coarse particle size, and may lodge on the walls of the canal and prevent the root canal filling from seating at correct level. Manipulation Root canal cement is mixed on sterile glass slab with spatula. Two or 3 drops of liquid is used and slowly small increments of cement powder is added to the liquid and spatulated to a smooth creamy consistency.

26. Wach’s Sealer Was developed by Dr. Edward Wach of the University of Illinois. Introduced in 1925 Reintroduced in 1955 Composition: Powder   Liquid   Zinc oxide 10g Canada balsam 20ml Tricalcium phosphate 2g Oil of cloves 6 ml Bismuth subnitrate 3.5g     Bismuth subiodide 0.3g     Heavy magnesium oxide 0.5g    

27. Properties : Medium working time. Minimum lubricating quality. Minimal periapical irritation. Sticky, due to the presence of Canada balsam. Increasing the thickness of the sealer lessens its lubricating effect, so this sealer is indicated when there is a possibility of over extension beyond the confines of the root canal. Indications : Small curved canals. In all lateral condensation methods. Contraindication: Heavy lubrications is needed as with short master cone.

28. Advantages It is germicidal. Less periapical irritation. It has light body, thus does not defect small G.P. cones. Disadvantages Odour of liquid

29. Base   Catalyst ZnO 57-59% Eugenol Bismuth trioxide 18.5-21.25% Polymerised resin Thymol iodide 3.75-5% Annidalin Oil + waxes 10-10%   Barium sulphate     Tubliseal Introduced in 1961 Two paste system Base Catalyst

30. Advantages: Easy to mix Extremely lubricating Does not stain tooth structure Disadvantages : Irritant to periapical tissues. Setting time – 20 min on glass slab. 5 min in the root canal. Working time - <30 min & shorter in presence of moisture.

31. Indications : When apical surgery is to be performed immediately after filling. Because of greater lubricating property, it’s a good choice for use when it becomes difficult for a master cone to reach last millimeter of preparation.

32. Setting reaction of ZnO eugenol cement Advantages: Sufficiently plastic Ease of manipulation Adhesion to the dentinal walls. Radio-opaque with some germicidal properties. Minimal staining. Ample working time. Disadvantages : Irritant to periapex . Not easily absorbed from apical tissue.

33. Biocompatibility: Cytotoxic Undergo dissolution – release irritants Inflammation in periapical area persists for years

34. CHLOROPERCHA [chloroform + gutta percha] Not adhesive Increased shrinkage Decreased radiopacity Chloroform – potential carcinogen EUCAPERCHA eucalyptol gutta percha CALLAHAN- JOHNSTON TECHNIQUE [DIFFUSION TECHNIQUE] Chloroform + rosin gutta percha KLOROPERKA N- Ø chloroform + resin + zinc oxide gutta percha

35. Chlorpercha This is a mixture of gutta-percha and chloroform. Made by mixing white gutta-percha with chloroform. Gutta – percha – 9.0 Chloroform – 91.0 The chloropercha paste has been used by some clinicians as the sole canal filling material Allows gutta – percha to fit better in the canal

36. Indications : This technique is useful in perforations and unusually curved canals or canals with ledge formations. It is used in conjunction with well fitted primary cone. Chlorpercha can fill accessory canals and root canals space. Disadvantages: Has no adhesive properties 1mm of chloropercha has radiodensity of 1.2 – 2.7mm of Aluminium Shrinkage because of evaporation of chloroform Technique is very sensitive to proper manipulations Chloroform Concerns about toxicity and carcinogenicity Known hepatotoxin

37. Modified chlorpercha methods : Johnson – Callahan and Nygaard – Ostby Johnston-Callahan method: The canal is repeatedly flooded with 95% alcohol. Then dried with absorbent points. It is then flooded with Callahan resin, chloroform solution for 2-3 minutes (more chloroform is added if the paste becomes too thick by diffusion / evaporation. A suitable gutta-percha is inserted and compressed laterally and apically with a string motion of the plugger until the gutta-percha is dissolved completely in the chloroform solution in the root canal.

38. Additional points are added one at a time and dissolved in the same way. Extrusion should be prevented because freshly prepared chloroform is toxic before evaporation of chloroform (as chloroform evaporates – it shrinks and apical seal is lost). NYGAARD OSTBY The canal walls are coated with kloroperka the primary cone dipped in sealer is inserted apically. Pushing partially dissolved tip of the cone to its apical seal. Addition cones dipped in sealer are packed into the canal to obtain satisfactory filling. FDA has banned the use of chloroform since it has a carcinogenic potential.

39. Kloroperka N-O sealer This formula was suggested by Nyborg and Tullin in 1965. Powder   Liquid Canada balsam 19.6% Chloroform Resin 11.8%   Gutta-percha 19.6%   Zinc oxide 49%   The powder is mixed with liquid chloroform, after insertion chloroform evaporates leaving voids. It has been shown to be associated with a greater degree of leakage than other materials. NON-EUGENOL CEMENT

40. EUCAPERCHA: By Buckley Eucalyptol does not dissolve gutta percha rapidly as does chloroform Replaced chloropercha because chloroform considered a potential carcinogen Is a paste made by softening surface of gutta –percha in warm oil of eucalyptus (eucalyptol) The softened gutta – percha used to coat the canal wall with a thin film of eucapercha Same cone inserted and compressed with pluggers to the apical juncture Disadvantages Difficult to avoid overfilling the canal If extruded, acts as an irritant initially

41. Nogenol : To overcome the properties of Eugenol Base Accelerators ZnO Hydrogenated rosin methyl acetate Barium sulfate lauric acid Salicylic acid Chloethymol Cytotoxic in cell culture Neurotoxic – total inhibition of the action potential

42. CALCIUM HYDROXIDE SEALERS

43. Calcium hydroxide has been used in endodontics as a root-canal filling material, intra canal medicaments or as a sealant in conjunction with solid core materials, such as gutta-percha. The use of Ca(OH) 2 paste as a root-canal filling material is based on the assumption that there is formation or hard structures or tissues at the apical foramen. The alkalinity of Ca( oH ) 2 stimulates the induction of mineralized tissue.

44. Calcium hydroxide and/or calcium hydroxide sealers can: Induce mineralization Induce apical closure via cementogencsis Inhibit root resorption subsequent to trauma Inhibit osteoclast activity via an alkaline pH Seal or prevent leakage as good as or better than ZOE sealers Less toxic than ZOE sealer. An endodontic sealer based on calcium hydroxide must dissolve and the solid consequently lose content. Thus one major concern is that the calcium hydroxide content may dissolve, leaving obturation void.

45. CRCS: Introduced in 1982 Termed the calcibiotic root canal sealer was the first of the calcium hydroxide based sealer. Is a zinc oxide eugenol eucalyptol sealer to which calcium hydroxide has been added for its osteogenic effect. Composition Powder Liquid Zinc oxide Eugenol Hydrogenated rosin Eucalyptol Barium sulfate   Calcium hydroxide   Bismuth dioxide  

46. It is mixed like any other powder:liquid sealer sets both in dry and wet canals. Ca(OH)2 + Eucalyptol  osteogenic effect It takes 3 days to set fully in either dry or humid environment, shows little water sorption which makes it stable and improves its seal and quality.

47. Sealapex : (Kerr) Non eugenol calcium hydroxide polymeric resin root canal sealer. It is delivered as paste to paste formulation. Composition : BASE ZnO with Ca(OH) 2 , Butyl benzene, Sulfonamide and CATALYST Barium sulfate, Titanium dioxide as radioopacifiers with proprietary resin Isobutyl salicylate and Acrocil R 972. Zinc stearate

48. PROPERTIES: Has poor cohesive strength Easily disintegrate in the tissue and causes chronic inflammation Claims of therapeutic effect Takes a long time to set Absorbs more water (may be due to its porosity) and expands while setting

49. Biocalex : Developed and introduced by Bernard in 1952. Composition Powder Liquid Heavy calcium oxide Glycol Zinc oxide Water

50. Powder and liquid are mixed to form a paste. Progressively expands to more than 6 times its original volume. So it is not necessary to prepare the root canal prior to root canal filling. Calcium oxide and water react within the tooth to form the calcium hydroxide which ionizes to release OH ions. These OH ions decomposes necrotic pulpal tissue to form water and carbondioxide .

51. Life Calcium hydroxide liner and pulp capping material similar in formulation to seal apex. Vitapex Introduced by Japanese researcher Calcium hydroxide sealer containing 40% iodoform , also contain silicon oil. Advantage Iodoform a known bactericide is released from the sealer to suppress any lingering bacteria in the canal or periapex .

52. Concerns over calcium hydroxide sealers Based on current information in the literature, it can be concluded that in terms of leakage, calcium hydroxide–based sealers are not superior to other groups of sealers Calcium hydroxide–based sealers had a statistically insignificant association to the rapid healing of apical periodontitis The limited antibacterial activity of calcium hydroxide sealer might be attributed to a lack of sufficient pH elevation, limited solubility, and diffusibility of calcium hydroxide into dentinal tubules - possibly buffering ions present in the tubules

53. Resin based sealers

54. POLYKETONE BASED SEALER DIAKET: Diaket is a polyvinyl resin ( Polyketone ), a reinforced chelate formed between zinc oxide and diketone . It was introduced in Europe by Scheufele in 1952. It’s a Modified zinc oxide cement widely used in Europe either with gutta percha or alone as a paste fill material.

55. COMPOSITION POWDER Zinc oxide Bismuth phosphate. LIQUID Propionylacetophenone (B- diketone ) Copolymers of vinylacetate , vinyl chloride and vinyl isobutyl ether Triethanolamine Caproic acid Dichlorophen Diaket consists of a fine, pure white powder and a viscous, honey colored liquid. Two drops of liquid are mixed with one scoop or powder.

56. PROPERTIES Powder: Liquid ratio – 1:2 Very tacky material- difficult to manipulate Good adhesion Sets quickly in the root canal at room temperature (3-4 min) Good volume stability Low solubility Superior tensile strength Is highly toxic and causes extensive tissue necrosis Irritation is long lasting. Has a greater tendency towards fibrous encapsulation if extruded . DIAKET A: Diaket A is a polyvinyl resin in a polyketone vehicle. Chemically this sealer is similar to diaket but it also contains the disinfectant hexachlorophene. Diaket is one of the few medicated cements, which does not contain paraformaldehyde .

57. EPOXY BASED SEALERS AH - 26: ( Dentsply / deTrey , Zurich): This is an epoxy resin recommended by Shroeder in 1957. Epoxy resin based sealers are characterized by the reactive epoxide ring and are polymerized by the breaking of this ring. Feldman and Nyborg gave the following composition. Powder: Bismuth oxide 60% Hexamethylene tetramine 25% Silver powder 10% Titanium Oxide 5% Liquid: Bisphenol A diglycidyl ether.(BADGE)

58. Derives its name from A- Aethoxylinharz (German) for ethoxyline base H- Hexamethylene tetramine 26- Was the test number Properties: 1. It has good adhesive property. 2. It has good flow 3. Antibacterial 4. It contracts slightly while hardening 5. Low toxicity and well tolerated by periapical tissue. 6 . Has good handling characteristics 7 . Can be warmed on a glass slab over an alcohol flame to decrease viscosity.

59. AH 26 consists of a yellow powder and viscous resin liquid and is mixed to a thick creamy consistency. The setting time is 36 to 48 hours at body temperature and 5-7 days at room temperature The long setting time and material fluidity results in no cracking or rapid separation from dentinal walls. AH26 produces greater adhesion to, dentin especially when smear layer is removed. Smear layer removal exposes the dentinal tubules creating an irregular surface thus enhancing adhesion.

60. AH Plus: AH Plus is a two-component paste: root canal sealer based on epoxy­- amine resin chemistry. This easy-to-mix sealer adapts closely to the walls of the prepared root canal and provides minimal shrinkage upon setting as well as outstanding long-term dimensional stability and sealing properties. Composition: AH Plus Paste A: BADGE Calcium tungstate Zirconium oxide Silica Iron oxide pigments AH Plus Paste B: Adamantane amine (N,N-dibenzoyl-5-oxanonane-diamine-I.9-TCD-diamine) Silica Silicone oil

61. The working time is at minimum 4 hours at 23 c The setting time is at minimum 8 hours at 37 °c Advantages: Excellent biocompatibility User-friendly handling and application Optimal working time and easier removal Outstanding physical properties Excellent radiopacity Suitable for all root canal obturation techniques.    

62. Adverse reactions: With sealers containing epoxy resins, the following adverse reactions were reported: Reversible acute inflammation of the oral mucosa after contact with the unset paste. In individual cases, local and systemic allergic reactions have been reported.

63. AH-26 Powder-liquid system When freshly prepared releases small amounts of formaldehyde Antibacterial Toxic Staining Film thickness-39µ good flow Sets slowly in 24-36 hours Is not sensitive to moisture and has low solubility AH-PLUS Paste –paste system Less toxic New amines added to maintain the natural colour of the tooth Half the film thickness Better flow Shorter setting time of 8 hours Has half the solubility of AH-26

64. Methacrylate based sealers Methacylate resins added to the sealers. 4 generations: 1 st generation – Hydron 2 nd generation – Endorez 3 rd generation – Fiberfil, Epiphany 4 th generation - Metaseal J Endod 2010

65. Creation of a solid, bonded, continuous material from one dentinal wall of the canal to the other such that it perfectly seals without forming any gaps or voids

66. Hydron : Introduced by Wichterle and Lim in 1960 Rapid setting hydrophilic, plastic material used as a root canal sealer without the use of a core. Hydron is a polymer of hydroxy ethyl methacrylate . It is available as air injectable root canal filling material. Require the use of special syringe and needle. Working time is 6-8 minutes. Setting time is 10 minutes. Advantages: Biocompatible material that confirms to the shape of the root canal because of its plasticity.

67. Disadvantages: Syringe method makes it difficult to control placement of gel accurately. Radiopacity is very low, this complicates the radiographic observation of an overfill. Several investigators have indicated that overfilling with hydron causes long-term periapical inflammation so tissue tolerance of hydron is controversial. It cannot be removed from the canal, retreatment is difficult. Pyner reported a case of Parasthesia from overfilling of lower molar.

68. ENDO REZ ( Ultradent Products, South Jordan, UT ) Hydrophilic, non etching dual cure radiopaque sealer Supplied in a Two- Spense mixing and delivery syringe COMPOSITION Zinc oxide Barium sulfate Resins Pigments In a matrix of urethane dimethacrylate resin

69. PROPERTIES Has radiopacity similar to gutta percha cones Does not compromise the use of dentin bonding agents Preliminary observations Excellent sealing properties Good adaptation to the root canal walls in the presence of moisture Effective penetration of material into the dentinal tubules Stayed soft and plastic for a long period of time.

70. EPIPHANY ROOT CANAL SEALER ( Pentron Clinical Technologies) I s a dual-curing, hydrophilic resin sealer U sed with Resilon core materials D ispensed from a double barrel, auto-mix syringe for greater ease of use . accurate mixing

71. Composition Resin matrix Mixture of Bis GMA Ethoxylated Bis GMA UDMA Hydrophilic difunctional methacrylates Fillers Calcium hydroxide Barium sulfate Barium glass Silica Total filler content 70% by weight Epiphany Primer/adhesive Self-etch primer Contains sulfonic acid terminated functional monomer HEMA Water polymerization initiator

72. Properties B onds to both the Epiphany Primer and Resilon obturating material can be light cured for an immediate coronal seal self cures apically in 25 minutes shrinks 2-3% on polymerization highly radiopaque easy to remove Resorbable less irritating than epoxy resin or ZOE sealers

73. Advantages Adheres to the sealer Excellent sealing capability due to creation of a “ monobloc ” which adheres to the dentin walls Provides an immediate coronal seal Shrinks only 0.5% even heated DISADVANTAGES: Polymerization shrinkage Cytotoxic when extruded Water sorption leads to disruption of bonds Bond strength lesser than conventional GP/sealer

74. Glass Ionomer Sealer Recommended by Pittford in 1970. reintroduced by Ray and seltzer in 1991 Marketed as Ketac Endo. During setting they form a hard polysalt gel which adhere tightly to dentine, because of their adhesive qualities, they can potentially be used as root canal sealers. It can be triturated and injected in the root canal.

75. Advantages : It has good physical properties. Initial good bonding to dentin. Few voids. Low toxicity. Disadvantages : Difficult to remove. Retreatment is difficult

76. Poly carboxylate cement: Composition Powder Liquid Zinc oxide Polyacrylic acid Properties Chelating action, bonding to both enamel and dentin. Because of its adhesive and antibacterial properties, the cement has been tested as a root canal sealer.

77. Advantages : It bonds well to dentin. Antibacterial property. Compounds like fluoride and calcium hydroxide can be added. Disavantages : Special plastic plugger is required for insertion since it has great adhesiveness to steel instruments. Apical seal is found to be inferior to other sealers. Exhibits inflammatory response when extruded out of the apex.

78. Riebler’s paste Powder Liquid Zn oxide Formaldehyde Formaldehyde Sulfuric acid Barium sulfate Ammonia Phenol Glycerine MEDICATED CEMENTS Paraformaldehyde based Composition:

79. Mynol cement Powder Liquid Zn oxide Eugenol Iodoform Creosol Resin Thymol Bismuth subnitrates   Used without core materials, Introduced into the root canal by means of either a lentulospiral or some type of injection device. Iodoform based Composition:

80. N2 Introduced by Sargenti in 1961 N2 refers to the so called second nerve. Initially 2 different types of N2 sealers were available : N2-Normal – Used for root filling. N2-Apical – Used for antiseptic medication of canal. Recently N2-‘Universal’ a cement containing the features of both N2-Normal and N2-Apical has been introduced. The formula has been altered by removing hydrocortizone , prednisolone and barium sulfate

81. Composition of N2-Universal Powder   Liquid Zinc oxide 68.51g Eugenol Lead tetroxide 12g Cleum Rosea Paraformaldehyde 4.7 Cleum Lavandular Bismuth subcarbonate 2.60g   Bismuth subnitrate 3.7g   Titanium dioxide 8.4g   Phenyl mercuric borate 0.09 g  

82. Coagulation necrosis reaches max. in 3 days tissue is unable to undergo repair for months due to formaldehyde impregnation with time formaldehyde washes away bacteria re-establishes or repair if blood supply is good seen as localized inflammatory reaction

83. Toxicity : Degree of irritation is severe when overfilling with N2 is forced into the maxillary sinus or mandibular canal persisting paraesthesia was observed. Blood lead level is increased after the insertion of root filling. Effectiveness of sealers : Apical seal with N2 is better when compared to procosol , nogenol , tubliseal and diaket .

84. Endomethasone : The formulation of this sealer is very similar to N2 composite. Pink antiseptic powder Composition Endomethasone root canal sealers give rise to pain or discomfort after 6-8 weeks of insertion. This occurs because corticosteroids masks any inflammatory reaction until it is removed from the area. Powder   Liquid Zinc oxide 100g Eugenol Bismuth subnitrate 100g   Dexamethasone 0.019g   Hydrocortisone 1.6g   Thymol iodide 25.0g   Paraformaldehyde 2.20g  

85. SPAD : One visit non irritant radioopaque filler and sealer. It is a resorcinal formaldehyde resin supplied as a powder and two liquids. Composition Powder   Liquid (Clear)   ZnO 72.9g Formaldehyde 57.0g Barium sulfate 13.0g Glycerine 13.0g Titanium dioxide 6.30g     Paraformaldehyde 4.70 Liquid (Red)   Hydrocortizone acetate 2.00g Glycerine 55g Calcium hydroxide 0.44g Resorcinal 25g Phenyl mercuric borate 0.16g Hydrocloric acid 20g

86. Manipulation Equal parts of the 2 liquids are mixed with the powder. The essential reaction to form the resin is between the resorcinal and the formaldehyde. Setting time of SPAD is 24 hrs. Indications : Pulpotomies in both deciduous and permanent teeth. For treatment of acute endo infection. Teeth with periapical areas. When SPAD is used in treatment of periapical infection a small amount is intentionally introduced beyond the apex with the belief that sterilization helps healing.

87. SILICONE-BASED ROOT CANAL SEALERS Silicone is inert and biocompatible and has been widely used in medicine as an implant material. Silicone-based root canal sealers are now available.

88. Endofill ( Lee Endofill ): Injectible silicon resin sealer Used with / without core material Least non toxic – least irritating sealer Base Catalyst Bi subnitrate Tetraethylorthosilicate Hydroxly dimethyl poly siloxane Benzyl alcohol Polydimethylsiloxane Sets to a rubbery solid similar to gutta percha

89. Adv: Ease of preparation Adjustable WT- Setting time can be adjusted from 10-60 min Low working viscosity Easy to remove - due to rubbery consistency Disadv : Cannot be used with H2O2 – canal should be dried Shrinks on setting – but has affinity to flow in open tubules Endo-fill's bonding ability to the canal walls decreases if it is not used within about 20 min of mixing.

90. ROEKOSEAL: Is a polydimethyl siloxane based root canal sealer Composition: Polydimethylsiloxane Silicone oil Paraffin-base oil Hexachloroplatinic acid Zirconium dioxide Properties: Flow properties: RoekoSeal has excellent flow properties. RoekoSeal easily spreads throughout the canal, sealing all areas. Insolubility: Most standard toot canal sealers are soluble to varying degrees. RoekoSeal provides an insoluble sealer for long lasting, reliable root canal obturation.

91. Dimensional stability: RoekoSeal does not shrink but actually expands slightily (0.2%). provides excellent seal against bacteria. Biocompatibility: Standard sealers show toxicity ranging from “slight" through "medium" to "severe". Cell tests, tests for mutagenic effects and sensibilisation tests all showed negative results with RoekoSeal . RoekoSeal is extremely biocompatible. Less cytotoxic than Kerr’s pulp canal sealer Al – Awadhi et al 2004

92. Does not contain eugenol It is highly radiopaque for an excellent x-ray evaluation. No antibacterial activity Cobankara et al 2004 RoekoSeal is available Automix syringe one double-barrel syringe 12 flexible mixing tips Single Dose package

93. Gutta Flow It is the first sealer guttapercha combination that is flowable at room temperature. The guttapercha powder is extremely fine with particle size <30µ. Nanosilver provides a preservative effect. Composition: Polydimethylsiloxane Silicone oil Paraffin oil Platinum catalyst Zirconium dioxide Nano -silver Gutta-percha powder It is packaged in inidividual use capsules that provides a safe, simple and hygienic delivery procedures

94. MTA based sealers Endo -CPM- Sealer , MTA Obtura and ProRoot Endo Sealer The composition of CPM sealer is reported to be 50% MTA (SiO2, K2O, Al2O3, SO3 , CaO and Bi2O3), 7% SiO2, 10% CaCO3, 10% Bi2O3, 10% BaSO4, 1% propylene glycol alginate, 1% propylene glycol, 1%sodium citrate and 10% calcium chloride

95. Sealers based on MTA have been reported to be biocompatible, stimulate mineralization (Gomes- Filho et al. 2009), and encourage apatite-like crystalline deposits along the apical and middle thirds of canal walls (Weller et al. 2008) These materials exhibited higher push-out strengths than Pulp Canal Sealer (PCS) particularly after storage in simulated body fluid (Huffman et al. 2009) Similar sealing properties to epoxy resin-based sealer when evaluated using the fluid filtration system (Weller et al. 2008).

96. Apatite rot canal sealers Root canal sealer containing tetra calcium – dicalcium phosphate & 1%Chondroitin sulphate Unfilled Bis -GMA resin sealers Newer Sealers

97. Appetite Root Canal Sealer Composed of hydroxyapatite and tricalcium phosphate. 3 types. Type I Powder Tricalcium phosphate – 80%. Hydroxy apatite – 20%. Liquid Polyacrylic acid – 25%. Water – 75%. This is used for vital pulpectomy . Tricalcium based Sankin apatite root canal sealer

98. Type II Powder : Tricalcium phosphate – 52%. Hydroxyapatite – 14% Iodoform – 30%. Liquid Polyacrylic acid – 25% Water – 75% Used in infected canals

99. Type III: Powder Tricalcium phosphate – 80%. Hydroxyapatite – 14% Iodoform – 5% Bismuth subcarbonate – 1% Liquid: Polyacrylic acid – 25% Water – 75% Used in cases of accidental perforation and retrograde filling material.

100. Adv: Biocompatible Osteogenic potential Low tissue toxicity Disadv : Sets quickly Low radiopacity Low wetting ability

101. Newly Developed Calcium Phosphate type Sealers: Tetracalcium Phosphate ( TeCP ) Dicalcium Phosphate Dihydrate (DCPD) TD Modified MC Ivain’s & Buffer Solution (TDM) TDM – S – Buffer Solution + 2.5% Chondroitin Sulphate

102. Powder Liquid Tetracalcium Phosphate Citric Acid Dibasic Calcium Phosphate Dibasic sodium Phosphate Chondroitin Sulphate Distilled water Excellent biocompatibility – no periapical reaction seen Chondroitin – promotes wound healing TDM –S

103. SEALER PLACEMENT Coating the master cone and placing the sealer in the canal with a pumping action. Placing the sealer on the final file used at the corrected working length and turning the file counterclockwise. Placing the sealer in the canal with a lentulo -spiral drill. Injecting the sealer with special syringes.

104. ROTARY OR SPIRAL PASTE FILLERS Used for placing initial sealer with solid core materials Completely filling the canal with paste filling Designed To be used in slow speed contra angle headpiece Can also be turned clockwise between fingers Basically 2 designs in use

105. Coiled wire Have long been used to place final cements and pastes High risk of fracture Should only be used for inserting provisional dressing Twisted blade Stronger rectangular blade Has more metal in cross section Less prone to fracture

106. Lentulo spirals available for hand use - More chances of sealer extrusion OTHER DEVICES: Used in a rotary motion: GUTTA CONDENSER ( Maillefer ) ULTRASONIC FILE (without coolant) K-FILE rotated counterclockwise Used in a non-rotary motion: SYRINGES VACCUM ( Lussi et al 1994)

107. Why sealers get extruded ? Anatomic considerations – open apex, resorbed ape Techniques of BMP – disruption of Apical constriction ? Misfit of GP master cone Pressure applied while Obturation Consistency of Root Canal Sealer Setting time of the Sealer

108. What happens if sealer extrudes ? Repair depends on... Resorbability of the Sealer Amount of Sealer extruded Individual patient response Blood supply of the area Extent of Pathology present at the Local site Corrective / Surgical corrective measures employed

109. Controversies in sealer Removal of smear layer is necessary Monobloc effect?? Technique of placement of sealer

110. Acceptable root canal sealer -- producing a seal while being well tolerated by periapical tissues. All the sealers -- good sealing abilities but none of them produce a leak proof seal. All of them produce some degree of periapical inflammation, ranging from mild to severe, in the initial few days after obturation. Most root canal sealers --of zinc oxide eugenol cement or resin Many of the other sealers like glass ionomer, AH-26, life, diaket , hydron etc have tested for their sealing efficiency but none of them have showed cent percent results.

111. Fortunately, the inflammatory process does appear to resolve completely and healing follows. Adhesive obturating materials are in the early stages of development. Current research on inorganic agents, which have the compatibility with biological tissue, the bioceramics i.e. hydroxyapatite sealers have been encouraging results Although none of the current materials appear to offer a big advantage over traditional obturating materials, none are likely to come to a disastrous end. However, continued research and development is likely to result in improvements and in new, more effective materials.

112. Conclusion With so many Sealers available to the dentists these days, it becomes a part of clinical judgement as to use which Sealer in a particular clinical situation.

113. REFRENCES Endodontics: Ingle, obturation of radicular space. 5 th and 6 th edition Pathways of pulp: Cohen, 10 th edition Endodontic therapy: Weine , canal filling with semisolid materials. Grossman’s Endodontic practice, obturation of the root canal, 12 th edition Restorative dental materials: Craig, cements. Richard S. Schwartz: adhesive dentistry and endodontics- a review, JOE, December 2006, 1125-1133. Ashraf El Ayouti et al.: homogeneity and adaptation of a new gutta percha paste to the root canals, JOE, September 2005,687-690.

114. Critical review on methacrlate resin based root canal sealers. Y K KIM et al..J Endod vol 36,no.3 pg 383-399 Adhesive dentistry and endodontics. Schwartz RS. J Endod 2005;31:151-65 Dynamic sealing ability of MTA root canal sealer J. Camilleri. International Endodontic Journal, 44, 9–20, 2011 Monoblocks in Root Canals: A Hypothetical or a Tangible Goal . Franklin R. Tay. J Endod 2007;33:391–398 A review of a resin-based root canal filling material Cora Hiu -Wan Ko , Hong Kong Dental Journal 2008;5:38-44 Calcium Hydroxide–Based Root Canal Sealers: A Review Shalin Desai. (J Endod 2009,1–6)