GOOD MORNING OBTURATION PARTI n n n n

GOOD MORNING ….

OBTURATION PART-I

n n n n DEF OF OBTURATION OBJECTIVES OF OBTURATION HISTORY – OBTURATION CLASSIFICATION OF OBTURATING MATERIALS APICAL LIMIT OF OBTURATION. ROOT CANAL SEALERS: CLASSIFICATION: n Gutta percha based sealers. ZNOE based sealers n Resin based sealers (Epoxy based). n

n Resin based sealers (Urethene methacrylate based sealer) n Calcium hydroxide based sealers. n Calcium phosphate based sealers. n Glass ionomer based sealers. n Formaldehyde based sealers. n Silicone based sealers. n Experimental sealers.

Introduction “perhaps there is no technical operation in dentistry where so much depends on the adherence to high ideals as that of pulp canal filling” Dr. Hatton 1924 It has been 4 decades since the late Dr. Herbert Schilder published his classic article on filling the root canal space in 3 dimensions. DCNA: Nov: 1967: 723 -744.

n Filling - instrumented root canal is final step in the fulfilment of an endodontic treatment regardless of whether the treatment was undertaken to remove vital pulp, necrotic pulp or infected pulp or a previous root canal filling. n The obturation phase of root canal treatment has always received a great deal of attention.

DEFINITION “The three-dimensional filling of the entire root canal system as close to the CDJ as possible with minimal amounts of root canal sealers, which have been demonstrated to be biologically compatible, are used with the core filling materials to establish an adequate seal” --American Association Of Endodontists (AAE) 1994

OBJECTIVES OF OBTURATION n Substitution of an inert filling in the space previously occupied by the pulp tissue n To eliminate all avenues of leakage from the oral cavity or the periradicular tissues into the root canal system. (i. e. to attain a three dimensional fluid impervious seal apicaly, laterally and coronally within the confines of the root canal system)

n n To adequately seal iatrogenic causes such perforations, ledges and zipped apices. Radiographically: n To attain a radiographic appearance of a dense three dimensional filling which extends as close as possible to the cemento dentinal junction without gross over extension or under filling in the presence of a patent canal

n n AAE: Obturated root canal should reflect a shape that is approximately the same shape as the root morphology and it should have a continious tapered funnel preparation without excess removal of tooth structure at any level of the canal system. Lack of complete obturation – IS the most frequent cause of failure. n Dow and Ingle (JOE 1982) demonstrated that nearly 60% of endodontic failures were caused by an incomplete obturation of the root canal system

HISTORY

► 200 B. C. – oldest known root canal filling with bronze wire - found in the root canal in the skull of a Nabatean warrior ► 1825 - Gold foil Hudson ► was used as root canal filing by Edward Other materials §Lead, Paraffin, Amalgam, Wood points, §Ivory, Orangewood sticks In 1843, Gutta percha was 1 st introduced by Sir Jose d Almeida to Royal Asiatic Society of England. Edwin Truman was the first man to introduce Gutta percha to Dentistry as a temporary restorative material.

n 1847 - Asa Hill developed first gutta –percha material known as Hill’s stopping n Consisted of bleached gutta-percha & carbonate of lime and quartz. n 1867 -Bowman, 1 st use of gutta percha for obturating a root canal in an extracted first molar

► 1883 -Perry claimed the use of : §Pointed gold wire wrapped with soft gutta-percha §Gutta percha rolled into points and packed into the canal §Chemical softening of shellac coated gutta percha using alcohol. Ø 1887 - S. S. White Company began to manufacture Gutta percha points

n 1893 -Rollins introduced new type of gutta percha to which he added vermilion (pure oxide of mercury) n 1899 - 1 st endodontic radiograph by Edmund Kells. n Canals were not cylindric n Need for additional filling material

► 1898 - Gysi introduced a formaldehyde paste- Gysi’s Triopaste ► 1933 - Jasper introduced silver points ► 1946 - Sommer provided the technical essentials of application of the lateral condensation technique ► 1953 - Berg demonstrated - essentials of vertical condensation ► 1967 - Schilder popularized vertical condensation technique. ► 1977 - Yee et al introduced the injectable thermoplasticized gutta-percha technique

► 1979 - Mc Spadden introduced a special compactor for softening gutta percha by friction ► 1984 - Michanowicz introduced a low temperature (70 C) injectable thermoplasticized gutta-percha technique- Ultrafil ► 1994 - James B. Roane - Inject R-Fill technique ► 1996 - Steven Buchanan developed a new method of vertical compaction of warm gutta percha - continuous wave of condensation technique (System B)

CLASSIFICATION OF ROOT CANAL FILLING MATERIALS (by Grossman) ►SOLID – CORE MATERIALS §Metals §Plastics §Cements/pastes ►SEALERS §Plastics §Cements §Pastes

1984 ANSI/ADA Specification No. 57 Endodontic filling materials --- Richard Burns: Chap: 8. §Type I ► Core (standardized) and auxiliary (conventional) points to be used with sealer cements §Class 1 – Metallic §Class 2 – Polymeric §Type II ► Sealer cements to be used with filling materials § Type III Filling materials to be used with or without the use of cements ► sealer

1994 ANSI/ADA Specification No. 78 Endodontic obturation points §Type I ► Core standardized points to be used with sealer & cement §Type II ► Auxiliary G. P (conventional or accessory points) of non standardized taper

ADA Specification No. Materials 57 Endodontic sealers 78 Endodontic obturating material 73 Dental absorbent points 71 Condensers, pluggers & spreaders

Hermetic seal : myth or misconception Grossman principle - 9 n Often cited as a major goal of root canal treatment in the achievement of a hermetic seal n According to dictionary definitions hermetic means “sealed against the escape or entry of air or made air tight by fusion or sealing” n Endodontically speaking the term hermetic is inappropriate and term such as fluid tight , fluid impervious, impermeable seal or bacterial tight seal - more accurate terms. . n Mid 1960’s --- Hermetic seal----Grossman n 1982 --- Fluid impervious seal ----Ramsey

Apical position/limit of the Obturation Although filling entire root canal system is major goal canal obturation. n A major controversy exists as to where to end the apical termination of the root canal filling material n W. L determination often cites the CDJ or apical constriction as the ideal position for terminating the C & S procedures and the point to which obturation should be placed

n The CDJ is a histological position and not a clinical position n The CDJ is not always the most constricted portion of the canal. n The distance from the apical foramen to the constriction depends on many factors like – increased cementum deposition, radicular resorption, age, Orthodontic movement, periradicular pathology etc

BEYOND THE RADIOGRAPHIC APEX RHEIN (1922) MAISTO (1948) HESS (1954) ‘APICAL PUFF’ OR ‘BUTTON’ To compensate for shrinkage of the filling As an indicator that gutta percha has been densely packed in to apical preparation All abberations, lateral and accessory canals have been cleansed and filled. IEJ-1998: 31: 384 -393.

AT THE RADIOGRAPHIC APEX: SCHILDER (JOE: 1967) Must fill lateral and apical ramifications. . CDJ/ apical constriction is variable CASTELLUCEI & BECCIANI (JOE: 1992) Radiographic apex fixed point,

SHORT OF RADIOGRAPHIC APEX: NYGAARD – ØSTBY (JOE: 1961) Apical space filled by connective tissue TORNECK (1966) SELTZER (JOE: 1964) SJOGREN (JOE: 1990): Obturation materials (especially sealers) may elicit sensitivity and immune response and should remain in the canal

SHORT OF THE RADIOGRAPHIC APEX AT THE CEMENTO DENTINAL JUNCTION AT THE APICAL CONSTRICTION 2 – 3 mm SHORT

AT THE CEMENTO DENTINAL JUNCTION GROVE (1929) CDJ - maximal apical constriction - pulp tissue ends KUTTLER ( 1951, 1955, 1958) – IEJ: 2006: 39: 595 -609. CDJ - is approximately 0. 5 -0. 7 mm from external surface of apical foramen. CDJ --- 0. 5 mm from A. P in young people 0. 75 mm from A. P in older individuals

AT THE APICAL CONSTRICTION LANGELAND (1957, 1967, 1987, 1995) CDJ Histologic structure Not detected radiographically Can be detected only clinically, Highly irregular-Not a constant feature. SELTZER et al (1964) Minimizes irritation of periapical tissues IEJ-1998: 31: 384 -393

2 – 3 mm SHORT (PARTIAL PULPECTOMY): DAVIS (1922) Apical periodontium not challenged Apical pulp stump acts as a barrier TRONSTAD (1979) SJOGREN et al (1990) Apical pulp tissue more resistant to disintegration; probably due to substantial blood supply AND Ultimately it gets replaced by fibrous tissue.

DEFINITION OF TERMINOLOGIES Schilder: DCNA: 1967 n Overfilling: n 3 dimensional obturation of the root canal space with excess material extruding beyond the apical foramen n Underfilling: n The apical seal is obtained but the canal space is incompletely filled leaving voids as potential areas for recontamination or infection Overextension: lack of 3 dimensional – with excess beyond n n Underextension: Canal space is incompletely filled without achieving apical seal

According to n SCHILDER: JOE 2006: 32: 4: 284 -290. n n 3 dimensional obturation with only the surplus is beyond the apex –good prognosis… n Over extension- without 3 dimensional obturation ---poor prognosis - more cases of endodontic failures.

Timing of the root canal obturation The root canal is ready to be filled when the canal is cleaned and shaped to an optimum size and dried. Dry canals may be obtained with absorbent points except in cases of apical periodontitis or apical cyst, in which “weeping” into the canal persists. In case if pt presents- mild discomfort, pain, exudate, foul odour, perapical sensitivity, filling such a root canal which is known to be infected is risky. IEJ: 1997: 30: 297 -306. -------IEJ: 1994: 27: 47 -51.

MULTIPLE VISITS: SINGLE VISIT: ► Presence of acute signs and symptoms ► Isolation problems ► Presence of periapical pathology. ► Asympathomatic teeth. ► Vital pulp exposures ► Infected canals, exudate ► No periapical pathology ► Presence of a non vital pulp open to the oral cavity, retreatment cases ► JOE: MAY 1999: 25: 5 ► JADA: DEC 1981: 103. and sealing

MULTIPLE VISIT: § Treatment in a two visit model proposed as a standard (by Sjogren in 1991). ► 1 st appointment § extirpation & complete debridement and irrigation of root canal §application of calcium hydroxide for one week or more. ► 2 nd appointment or later appointment §obturation of root canal

REQUIREMENTS FOR AN IDEAL ROOT CANAL FILLING MATERIAL

GROSSMAN in 1940 modified Brownlee’s (1900) criteria for ideal root canal filling materials: ► Easily introduced ► Seal laterally as well as apically ► Not shrink after being inserted ► Impervious to moisture ► Bacteriostatic or at least should not encourage bacterial growth ► Radiopaque, Non- stain tooth ► Not irritate periradicular tissues ► Sterile or sterilizable ► It should be Easily removed if necessary.

OTHER REQUIREMENTS ARE: • Free of impurities and inclusions ► Uniform distribution of additives throughout ► Also should comply with ADA Document No. 41 for biological evaluation

ROOT CANAL SEALERS These are Cements / Resins / Semiliquid / which are used as binding agents to fill up the gap between walls of root canal and obturating material. n n It also fills up the irregularities, discrepancies, lateral canals and accessory canals. helps to achieve a proper seal.

REQUIREMENTS FOR AN IDEAL ROOT CANAL SEALER GROSSMAN’S 11 REQUIREMENTS (1958): ► Tacky when mixed – to provide good adhesion b/w it and the canal when set ► Make a hermetic seal ► Radiopaque – so that it can - visualized - radiograph ► Particles of powder should be very fine so that they can mix easily with the liquid ► Not shrink upon setting ► Not stain tooth ► Bacteriostatic or at least not encourage bacterial growth

► Set slowly ► Insoluble in tissue fluids ► Tissue tolerant i. e. , nonirritating to periradicular tissue ► Soluble in a common solvent if it is necessary to remove the root canal filling ADDITIONAL REQUIREMENTS ► Not provoke an immune response in periradicular tissue ► Neither mutagenic nor carcinogenic

Functions of sealers ► Serves as a filler for canal irregularities and minor discrepancies between the root canal wall and core filling material ► To obturate the lateral canals ► Acts as lubricant ► Enhances the possible attainment of an impervious seal ► Can assist in microbial control of root canal walls or in tubules

Factors to be considered in selection of sealers n These are determined by the need for each case n Working time of the sealer n Irritating potential of sealer, if it escapes into periapical tissues n Choice of intra canal irrigants and medicaments n Antimicrobial action n Biocompatibility

n According to composition: (MESSING): n 1. Eugenol containing: n A. Silver containing: Rickett’s formula of Kerr’s Sealer Procosol silver containing sealer. -1936 n B. Silver free: Procosol Non-staining cement (Grossman-1958) Grossman’s sealer Tubliseal (Kerr-1961) Wach’s Paste (Wach 1925)

2. Non-Eugenol sealers: n n n n DIAKET (1951) AH 26 (1957), AH Plus. Chloropercha, Eucapercha Nogenol Hydron Endofil Ketac-endo.

n 3. Medicated sealers: n N 2 Endomethasone Spad Iodoform paste Riebler’s paste n n

According to Grossman: n Zinc-oxide resin cements. Ca(OH)2 cements. n Paraformaldehyde cement. n According to Ingle: n Cements. Pastes. n Plastic. n According to Clark: n n Absorbable. Non-absorbable

Absorbable ►Kerr Sealer (Rickert) ►Grossman's ►Roth Sealer Nonabsorbable ►Diaket (polyvinyl resin) ►AH-26 (epoxy type resin), AH Plus Root Canal Cement ►Ketac Endo ►Tubliseal ►Sealapex , Tubliseal EWT

According to Cohen: Specification number 57 classifies endodontic sealing materials as follows: n Type I – Class 1, Class 2 n Type II – Cl 1, Cl 2, Cl 3 n Type III – Cl 1, Cl 2, Cl 3, Cl 4 n n Type I : Core (Standardized) auxiliary (conventional) points to be used with sealer cements. Class 1 – Metallic, Class 2 – Polymeric. Type II : Sealer cements to be used with core materials. Class 1 – Powder and liquid - nonpolymerizing. Class 2 – Paste and non-polymerizing. Class 3 – Polymer resin systems.

n Type III : sealers used with or without the filling materials, Class 1 – Powder and liquid - non-polymerizing. Class 2 – Paste and paste - non-polymerizing. Class 3 – Metal amalgams. Class 4 – Polymers. According to Harty’s: Pastes and cements may be divided into 5 groups: 1. Zinc-oxide eugenol based, 2. Resin based. 3. GP based, 4. Dentin adhesive materials. 5. Materials to which medicaments have been added.

GUTTA PERCHA BASED SEALERS

CHLOROPERCHA: ►Is a premixed sealer ►Made by mixing white gutta-percha with chloroform § Gutta – percha – 9. 0% § Chloroform – 91. 0% ►Highly plastic – forced into tortuous , fine canals ►Disadvantages §Has no adhesive properties, Inability to control overfilling §Shrinkage because of evaporation of chloroform §poor apical and lateral seal §Chloroform ►Concerns ►Known about toxicity and carcinogenicity hepatotoxin JOE: 2006: 32: 4: 281 -290

n Procedure: Small amt –chloropercha is streaked –on dry walls canal-fine spreader. n Apical 3 rd of master cone dipped –chloropercha paste and is repositioned into canal. n Material in the canal is now laterally forced –spreaders – making room for additional G. P cones- thus to obtain dense filling. n Each piece of G. P blends with eachother and to chloropercha already in the canal –thus forming homogenous mass & confines adequately to the entire root canal configuration. n Entire mass moves apicaly during lateral condensation

CALLAHAN – JOHNSTON TECHNIQUE / DIFFUSION TECHNIQUE-1914. n Root canal system is flooded with 95%ethyl alchohal & dried with paper points and canal is again flooded with chlororosin solution for 2 -3 min. n It spreads into inaccessible areas, accessory canals & it acts as solvent – when master cone & accessory cones are added and as condensation proceeds - dissolved G. P will diffuse effectively into all inaccessaible areas of canal. …JOE APRIL 2006: 32: 4: 281 -290.

n As all solvents r volatile---shrinkage occurs graduvally as root canal filling hardens. n If shrinkage is excess- failure occurs - inadequete sealing of the root canal n If excess solvent is used—gross excess of filling material may be forced into periapical, – solvent are irritants –cause irritation to tissues.

KLOROPERKA : ►By ►Is Nygaard – Ostby 1939 a powder / liquid mixture ►POWDER §Canada balsam Colophony resin White Gutta – percha 19. 6 11. 8 19. 6 §Zinc oxide 49. 0 Provides better: Adhesive properties Increases radiopacity Reduces shrinkage ►LIQUID §Chloroform 100. 0 and is a solvent.

n This Nygaard-Ostby tech is a variation Callahan. Johnson method ---here finely ground specially prepared gutta percha particles r spatulated with chloroform to make into paste which is used in conjunction with the master cone is placed in canal and obturated. n Reduces both apical excess and shrinkage in the final filling. . JOE APRIL 2006: 32: 4: 281 -290.

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 guttapercha in warm oil of eucalyptus (eucalyptol)

► The softened guttapercha is used to coat the canal wall with the paste in a thin film. ► 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

ZINC OXIDE EUGENOL SEALERS

KERR PULP CANAL SEALER n Developed in 1931 as RICKERT’S SEALER. n Developed as an alternative to gutta percha based sealers n Was introduced as KERR PULP CANAL SEALER in 1951 n Composition n POWDER Zinc oxide Silver White resins Thymol iodide n LIQUID Oil of Cloves , Canada balsam

PROPERTIES: ►Has ►Is germicidal and adhesive properties radiopaque ►Has severe staining properties because of silver content §discoloration of teeth ►Powder ►Has ►Is : liquid ratio – 1: 1 average tissue toxicity resorbed from periapical tissues over time ►Completely sets & inert within 15 -30 min

n n Now available in 2 versions n Regular Pulp Canal Sealer – regular set n Pulp Canal Sealer EWT – extended working time Pulp Canal Sealer EWT n Working time – 6 hours n Used with heated gutta percha technique Disadv: staining property: because – silver-enters into dentinal tubuli. …JOE: 1987: 13: 220.

TUBLI – SEAL (Kerr Dental) ►Developed ► 2 in 1961 as an alternative to Kerr’s Pulp Canal Sealer -staining Paste system in two tubes. Base - -catalyst. ►It’s a zinc oxide base paste with barium sulfate for radiopacity, mineral oil, corn strach and lecithin. ►catalyst tube: polypale resin, eugenol, thymol iodide. ►PROPERTIES: Adv : § Non staining sealer, white in colour § Quick and easy to mix § Expands on setting § Good radiopacity § Extremely lubricating – allows maximal compaction and packing

Disadv: n Appears to be irritating to periapical tissue n Rapid setting time(<30 min) especially in presence of moisture n Very low viscosity causes - extrusion. n n n Indications: when apical surgery is to be performed immediately after filling So Tubli-seal with EWT is introduced.

PROCOSOL RADIOPAQUE SILVER CEMENT n n n By Grossman 1936 Developed with the purpose of increasing the working time COMPOSITION n POWDER Zinc oxide , Silver (precipitated) Hydrogenated resin Magnesium oxide n LIQUID Eugenol Canada balsam, colophony. n Properties----Was staining (silver), eugenol, canada balsam, colophony –known contact allergens…

PROCOSOL NON STAINING CEMENT (Grossman 1958) n POWDER Zinc oxide 40. 0 Stabelite resin Bismuth subcarbonate Barium sulfate n LIQUID Eugenol Sweet oil of almond Fast setting… 80. 0 20. 0

GROSSMAN’S SEALER ►Developed by Harry Roth in conjunction with Dr. Louis Grossman 1974 ►Powder: ►Zinc oxide ►Staybelite ►Bismuth ►Barium resin subcarbonate sulphate ►Liquid: ►Eugenol ►Omission ►Most of oil of sweet almond, addition of anhydrous sodium borate widely used ideal sealer ►PROPERTIES: §Adequate plasticity [sodium borate] §Slow setting time [sodium borate]- (8 - 12 hrs)

ROTH’S 801 sealer: same as Grossman’s original formula. Substitution of bismuth subnitrate for bismuth subcarbonate. §Proper consistency: ►Smooth ►String creamy mix out test §Should string out at least an inch before breaking ►Drop test §Suspended mix should cling to the inverted spatula blade for 10 – 15 sec before dropping

n Factors affecting setting time n Quality of the Zn. O n Quality of the eugenol (oxidized and brown sets too rapidly) n Mixing technique n Amount of humidity in atmosphere n Temperature and dryness of mixing slab and spatula n p. H of the resin used n Amount of sodium borate JADA: 1958: 56: 381.

►ADVANTAGES § Good sealing potential because of small volumetric change on setting § Resorbs gradually if extruded apically § Reversible inhibitory effect on nerve tissue ►DISADVANTAGES § Is a weak unstable material § Decomposed by water through a continuous loss of eugenol.

WACH’S CEMENT ► developed by Dr. Edward Wach of the University of Illinois introduced in 1950 §Also known as SEALEX EXTRA ► COMPOSITION § POWDER Zinc oxide Calcium phosphate tribasic 61. 0 – 61. 4 12. 0 – 12. 2 Bismuth subnitrate Bismuth subiodide Magnesium oxide (heavy) § LIQUID Canada balsam Oil of c loves Eucalyptol Beechwood creosote 74. 0 – 76. 9 22. 0 – 23. 1

§ [Because of known toxicity, beechwood creosote removed from later formulations] ►PROPERTIES: § canada balsam –makes it tacky and sticky §Eucalyptol –solvent –softens the Gp -thus forms more homogeneous mass with Gp. §Working time – 15 to 20 min §Hot , humid – working time is shortened. §Germicidal, less periapical irritation. §Disadv: foul odour of liquid.

NOGENOL ►Non eugenol based sealer ►Developed ►It - overcome - eugenol available in 2 tube. Base and catalyst system. ►Base: zinc oxide, barium sulphate as radiopacifier, bismuth oxychloride, Veg oil. ►Catalyst: hydrogenated rosin, methyl abeitate, lauric acid, salicylic acid and chlorothymol accelerate the setting time. ►PROPERTIES §Less irritating to the tissues § Expands on setting and may improve the sealing efficiency with time JADA: 1958: 56: 381 -5 INGLE 6 TH EDITION.

RESIN BASED SEALERS ZNO BASED SEALERS

DIAKET : ► By Schmidt in 1951 Widely used in Europe either with gutta percha or alone as a paste fill material ► ►Polyketone comp containing vinyl polymers mixed with znoxide & bismuth phosphate to form an adhesive sealer

COMPOSITIONpowder: ZNO: 97%, Bismuth phosphate: 3%, Liquid: Dichlorophen, copolymers of vinyls, B-Diketone – 76% (propionylactophenone) Powder: Liquid ratio – 1: 2, Sets by chelation…… During setting – a chelate is formed b/w B-Diketone and Zn. O. Is tacky material -difficult to manipulate, contracts on setting…

n Properties: n good strength, low shrinkage, good adhesion to dentin, no allergic reactions, when extruded into periapex– slowly gets resorbed -shows– tendency to fibrous encapsulation, n n n hardens in 6 min after mixing so difficulty in lateral condesation techq. n Radiopacity – 4. 4 mm of Al, , difficult to remove….

RESIN BASED SEALERS EPOXY BASED SEALERS

AH-26 By Schroeder 1957 ► Is an Bisphenol epoxy resin sealer which uses methenamine for polymerization. It is characterized by reactive epoxide ring and are polymerized by breaking this ring. ► Derives its name from §A- Aethoxylinharz (German) for ethoxyline base §H- Hexamethylene tetramine § 26 - Was the test number

Presently used extensively as a sealer ►COMPOSITION - Feldman: ►POWDER: Silver powder - 10. 0, Bismuth oxide (radiopacity) - 60. Hexamethenamine - 25. 0, Titanium oxide - 5. 0. ►LIQUID - - Bis- phenol diglycidyl ether - 100%--mutagenic. AH 26 consists of a yellow powder and viscous resin liquid and mixed to a thick creamy consistency. It produces greater adhesion to dentin mainly when smear layer is removed. Radiopacity – 6. 66 mm of aluminium.

►PROPERTIES: Advantages : §High radiopacity, Low solubility, even sets under water. §Slight shrinkage , Tissue compatible, strongest antibacterial effect – compared to ZNOE, Cal hydroxide, GIC Sealers. Disadv : §As Hexamethenamine sets, formaldehyde gets released and highest release-24 hrs. toxicity is 300 folds less compared to N 2. §Extended setting time (36 -48 hrs) §Staining-because of silver - due to formation of black silver sulfides,

AH PLUS • • • Epoxide-amine resin sealer. shade and colour stability makes it as material of choice where esthetic demands r high. Easy to mix, minimal shrinkage, good long term dimensional stability and sealing properties & adopts closely to walls of root canal. COMP: silver removed-bismuth oxide added-radiopacity. AH Plus Paste A: Epoxy resins, cal tungstate, silica, iron oxide, zirconium oxide. AH Plus Paste B: Adamantianaemine, silica, bismuth oxide, silicone oil, N, N Diabenzyl-5 -oxanonane-diamine.

n Although AH PLUS contains calcium tungstate, but calcium release is absent. n Durate et al in 2003 suggested addition of 5% calcium hydroxide to AH Plus. to make the sealer less viscious & to provide more alkaline p. H and the release Cal & OH -will exert antimicrobial activity. n Mixing: 1: 1 ratio. On glass slab or paper pad with metal spatula to a homogenous consistency.

AH-26 ► ► Powder-liquid system When freshly prepared releases small amounts of formaldehyde ► Staining ► Film thickness-39µ §good flow AH-PLUS ► Paste –paste system ► Less toxic ► Amines are added – allow for polymerization with all the advantages of AH-26. ► ► Setting time - 24 -36 hours ► Good radiopacity ► ► Is not sensitive to moisture and has low solubility Also available as Therma Seal film thicknesses -18µ. §Better flow ► settingtime 4 -8 HR. ► Increased radiopacity ► Has half the solubility of AH-26 ► Therma Seal Plus /Top Seal

RESIN BASED SEALERS URETHENE METHACRYLATE BASED SEALERS

ENDO REZ Hydrophilic UDMA resin sealer, chemically set material ►Supplied in Two tubes – with a delivery syringe ►COMPOSITION §Zinc oxide §Barium sulfate §Resins §Pigments §In a matrix of urethane dimethacrylate

n Endo. Rez –introduced –canal – narrow 30 -gauge Navitip needle. Single Gp techq or lat comp obtu techq can be used. n EZ FILL: n Non eugenol epoxy resin-placed with a bidirectional spiral, rotating in hand piece –used with single G. P obtu techq. n Spiral designed to spread sealer in apical region of canal. n Non shrinking on setting and hydrophobic. Resistant to fluid degradation. n n

►PROPERTIES § Has radiopacity similar to gutta percha cones § Preliminary observations: § Excellent sealing properties - good canal wetting § Good adaptation to the root canal walls. § Effective penetration of material into the dentinal tubules

► ► FIBREFILL ROOT CANAL SEALANT Its composition resembles that of dentin-bonding agents COMPOSITION §Mixture of UDMA, PEGDMA, HDDMA and BIS-GMA resins §Treated barium borosilicate glasses §Barium sulfate §Silica §Calcium hydroxide §Calcium phosphates §Stabilizers §Pigments §Benzoyl peroxide ► Used in combination with a self - cured primer (Fibrefill Primer A&B)

n Manipulation: n mix equal no of drops of Fiber fill primer A & B, apply this mix into root canal. The main sealer which is a mix of base and the catalyst is then applied as an ordinary root canal sealer. n Fiberfill primer A: Mixture of acetone and dental surface active monomer NTG-GMA magnesium. n Fiberfill primer B: Mixture of acetone and dental methacrylate resins of PMGDMA, HEMA Initiator.

EPIPHANY ROOT CANAL SEALANT ►Is a dual-cure, hydrophilic resin sealer that self cures in 25 min. > used with Resilon core materials ►dispensed from a double barrel, auto-mix syringe §for greater ease of use §accurate mixing

►Composition: §Resin matrix ►Poly ethylene glycol dimethacrylate. ►Ethoxylated Bis. Phenol dimethacrylate. ►UDMA ►Hydrophilic difunctional methacrylates §Fillers ►Calcium hydroxide ►Barium sulfate ►Barium glass, pigments ►Silica Total filler content 70% by weight

n Properties n bonds to both the Epiphany Primer and Resilon obturating material n n can be light cured for an immediate coronal self cures apically in 25 minutes n shrinks 2 -3% on polymerization n Good sealing ability –monobloc effect, radiopaque. Strengthen the root by 20% Is easy to remove. Non-mutagenic, Non-cytotoxic, biocompatible. n n n

►Used in conjunction with § 17% EDTA / 2% chlorhexidine/saline. ►Na. OCl disrupts the dentin bond §Epiphany Primer: ►self-etch primer ►Contains §Sulfonic monomer acid terminated §HEMA §Water §polymerization initiator functional

Hydron n n n It - rapid setting hydrophillic, plastic material used as root canal sealer without the use of core. Hydron is a polymer of hydroxyethyl methacrylate (HEMA). Introduced by Wichterle & Lim -1960. It is available as an injectable root canal filling material. Working time is 6 to 8 minutes. The syringe method makes it difficult to control the its placement accurately. It is biocompatible material that confirms to the shape of the canal - when in comes in contact with moisture, the gel (Hydron) absorbs water and swells.

CALCIUM HYDROXIDE SEALERS

SEALAPEX ►Basically sealer ► a zinc oxide based calcium hydroxide containing polymeric resin Available in 2 tubes - 2 paste system ►COMPOSITION §BASE Zinc oxide, Calcium hydroxide Butyl benzene, Sulfonamide, Zinc stearate §CATALYST Barium sulfate, Titanium dioxide Isobutyl salicylate ( proprietary resin) Aerocil R 972

►PROPERTIES: §Has poor cohesive strength §Easily disintegrate in the tissue. §Claims of therapeutic effect §Takes a long time to set(3 weeks – 100% humidity) §never sets in dry atmosphere. §Absorbs more water (may be due to its porosity). §only sealer which expands while setting. §When overextended – provokes chronic inflammatory reactions in PDL.

CRCS (CALCIBIOTIC ROOT CANAL SEALER) ►Zinc oxide eugenol / eucalyptol sealer to which calcium hydroxide has been added ►COMPOSITION: §POWDER ►Zinc oxide ►Calcium ►Barium hydroxide sulfate ►Bismuth subcarbonate ►Hydrogenated resin ester §LIQUID ►Eugenol ►Euclayptol JOE: 1988: 14: 527.

►PROPERTIES: §Slow setting-Takes 3 days to set fully in dry/humid cond. §Ca(OH)2 is not readily released and therapeutic effect is limited. §Has poor cohesive strength §Set cement - Quite stable, shows very little water sorption §Causes chronic inflammation if extruded periapically §Easily disintegrate in the tissue

APEXIT: Colophonium based salicylate resin. ►Available as a paste-paste system. It is a calcium hydroxide sealer with salicylates incorporated into it. ►Adv: ►biocompatible calcium hydroxide base, easy to mix, radiopaque, hard setting

►COMPOSITION ►BASE Calcium hydroxide Zinc oxide Calcium oxide Silicon dioxide 31. 9% 5. 5% §ACTIVATOR Trimethyl hexadisalicylate 25. 0 Bismuth carbonate 18. 2 Bismuth oxide Tricalcium phosphate Zinc stearate

CALCIUM PHOSPHATE BASED SEALERS (APATITE SEALERS)

n n Acidic component Dicalcium phosphate dihydrate basic component Tetracalcium phosphate Mixed with water ---hard mass similar to hydroxyapatite Properties: n n n radiopaque as bone once it sets - insoluble in water, saliva and blood. Soluble in acids mild irritation OR no irritation – extruds. Promotes cementum like hard tissue deposition.

APATITE ROOT SEALER Type II APATITE ROOT SEALER Type I §POWDER ► - Tricalcium phosphate ►Hydroxyapatite ►Water ► - Tricalcium phosphate ►Hydroxygapatite ►Iodoform §LIQUID § LIQUID ►Polyacrylic §POWDER acid ► Polyacrylic acid ►Water has some amount of inflammation because of polyacrylic acid. PROPERTIES: Type III – Powder contains bismuth subcarbonate -1%. along with the type II ingradients of powder.

n Type I – used for VITAL PULPECTOMY cases n Type II, III – 30% iodoform used in INFECTED CANALS and is radiopaque and Bactericidal. Advantages: n n n Biocompatible. Osteogenic potential. Low tissue toxicity Disadvantages: n n n Sets quickly, hence multiple mix essential for late cond techq. Low radiopacity. Low wetting ability.

GLASS – I 0 N 0 MER SEALERS

KETAC-ENDO Introduced by Ray & Seltzer in 1991 ►PROPERTIES §Film thickness-22 microns §Working time in mouth 7 min so difficult in lateral cond techq , §No shrinkage upon setting, Radiopaque. §Presence of pores reduces the sealing quality. §Antibacterial effect - due initial low PH and fluoride release.

§Superior adaptation to canal walls (dentin bonding property) ►makes roots resistant to fracture ►has inherent potential of providing a more stable apical seal §Polyacrylic acid may chelate with zinc oxide of gutta percha cones by forming salt bridges ►hence earlier advocated for use in a single cone technique

§No known solvent - difficult to remove §Good biocompatibility in bone and tissue §Extruded sealer is highly resistant to resorption by tissue fluids and becomes an implant in the periapical tissues. §Composition: §powder: cilicic acid, pigments, calcium volframate, cal aluminium lanthanum flurosilicate glass. §Liquid: copolymer, tartaric acid, water, polyethylene polycarbonic acid.

MEDICATED CANAL SEALER -Developed by Martin. - It contains Iodoform for antibacterial purposes and is used with MGP, which also contains 10% Iodoform.

IODOFORM PASTE n used as sealer with core materials. n Walkhoff (1928). It is a resorbable paste. Consists of: 50% parts of iodoform. 45% parachlorphenol, 5% menthol. n n

n The disadvantage of iodoform paste is that it induces severe inflammatory reaction and with time discoloration of the tooth occurs if not removed from the pulp chambers. n The introduction of iodoform paste into the root canal may lead to rise in the iodine level in blood, hence contraindicated in patients who are sensitivity to iodine.

n ENDOFLOSS : Zn. O based medicated cement Powder: Zn. O, Iodoform, Ca(OH)2, Ba. SO 4 Liquid: Eugenol, Parachlorophenol. n S. T. 30 -45 minutes. n Biocompatible. Induces severe inflammatory reaction in 48 hr & gradually reduces after 3 months. n n Severe cytotoxicity along with coagulation necrosis was observed – attributed -presence of iodoform & parachlorphenol.

FORMALDEHYDE CONTAINING SEALERS

ENDOMETHASONE n widely used – Europe. n Pink antiseptic powder mixed with eugenol

n COMPOSITION: n POWDER n Zinc oxide, Bismuth subnitrate, Dexamethasone n Hydrocortisone acetate, Thymol iodide, Paraformaldehyde n LIQUID: Eugenol, peppermint oil, Anise oil. n Sometimes Endomethasone RC sealers gives rise to pain / discomfort after 6 to 8 weeks of insertion. n This occurs because the corticosteroid masks any inflammatory reactions initially. n Paraformaldehyde is not resorbed equally, quickly and the symptom of the inflammatory reaction becomes apparent

SPAD n Non-irritant-- radiopaque sealer---- is a Bakelite type Resorcinol –formaldehyde resin. n Powder-liquid system. n POWDER n n n Phenyl mercuric borate, Calcium hydroxide Titanium oxide, Barium sulfate, Zinc oxide LIQUID n Paraformaldehyde ------- 87%. n Hydrochloric acid, Resorcinol, Glycerine

n Principle is Resinifying therapy. n n n liquid contains paraformaldehyde and resorcinol when it is mixed with powder and placed in root canal it undergoes polymerization and gets solidified. Residual pulpal remnants r claimed to be resinified & rendered harmless. When this material sets –forms almost impermeable barrier.

n Recommended for pulpotomies in deciduous teeth and in treatment of acute endod inf. n Setting time- 24 hours during which - small quantities of formaldehyde is released. Disadv: inability to obtain compact obturation , to treat failed cases - as material - very hard once it sets, n Presence of voids, severe toxicity if sealer extruds into periapex. n

RIEBLER’S PASTE n Resin type of sealer containing Paraformaldehyde & is a trailement to SPAD. Widely used in Europe. n COMPOSITION: n POWDER n Zinc oxide n Formaldehyde (polymerized) n Barium sulfate n Phenol n LIQUID n Formaldehyde, Sulphuric acid n Ammonia, Glycerin

N 2 paste. ( Switzerland) Term coined by Angelo Sargenti- describe 2 nd nerve--pulp space. 1 st nerve-pulp. First used in Europe. N 2 paste is produced in US as RC 2 B. Available in liquid and powder form. ► Paraformaldehyde(6. 5%) containing zinc oxide – eugenol sealer ► Introduced by Sargenti and Ritcher in 1959 §Also known as ‘Sargenti technique –used as a sealer. The contents are changed over the yrs As leadoxide, organic Hg were completely removed from N 2, - but still contains Paraformaldehyde(6. 5%).

n COMPOSITION n n POWDER Barium sulfate Titanium dioxide Phenylmercuric borate Lead tetroxide LIQUID Znoxide, bismuth nitrate, bismuth carbonate, paraformaldehyde----6. 5% 2. 0 – 3. 0 0. 16 11. 0 – 12. 0

n PROPERTIES: n N 2 is very toxic, carci, muta, cytotoxic n Causes coagulation necrosis of the tissues in less than 3 days-localised tissue react… n Tissues altered to such an extent cannot undergo repair n When extruded into periapex- severe neurological dama n Loses substantial volume when exposed to fluid (Para formaldehyde)

ASSESSMENT – of formaldehyde sealers n n n Systemic distribution – Formaldehyde-(Block et al JOE: 1980) Mutagenic potential (Lewis and Chistner JOE: 1981) Periapical irritation & Bone necrosis - overfilling with – SPAD. -(Smith et al BDJ: 1978) Lower lip paraesthesia –N 2 and Spad , (JOE: Grossman 1978). Irreversible inhibition of nerve conductance. …BANNED BY ADA.

n American Association of Endodontics also says “use of Para formaldehyde containing materials for root canal obturation is below the standard of endodontic therapy”

SILICONE BASED SEALERS

n Silicone - introduced in 1984, 1 st product was based on C -silicone –condensation polymerizing silicone- causes mild irritation –extruded into periapical tissues. n Recently A-silicone-additional polymerization silicone was introduced – more dimensional stability than C. it releases ethanol during polymerization n Better sealing ability than calcium hydroxide or epoxy based sealers, non toxic, long term clinical behavior not available. . Text book of Endodontics - Bergenholtz

LEE ENDOFILL n Injectable silicone resin n Sets to a rubbery solid similar to gutta percha n Can be used to directly fill the canal (paste filler) using a precision syringe n Can also be used as a sealer with gutta percha n Paste is a distinctive pale pink colour n Reported to be non-toxic, least irritating , stable

n Composition n Base n Hydroxyl dimethyl polysiloxane n Benzyl alcohol n Hydrophobic amorphous silica n 10 – 30 millimicron particle size n Bismuth subnitrate n Catalyst n Tetraethyl orthosilicate n Polydimethyl siloxane

n Advantages n Ease of preparation n Rubbery consistency n As easy to remove as gutta percha Setting time can be adjusted from 10 -60 min n Has a low viscosity prior to setting n n allows good adaptation n Disadvantages n Cannot be used in presence of hydrogen peroxide or sodium hypochlorite n Canal must be absolutely dry n Shrinks on setting

ROEKOSEAL n Is a polydimethyl siloxane based - White paste like sealer & is Eugenol-free and Radiopaque n Extremely low film thickness of only 5 microns n Excellent flow properties n Even into the smallest dentinal tubules n Polymerizes without shrinkage & uses platinum as catalyzing agent & shows excellent seal against bacteria n Biocompatible n Less cytotoxic than Kerr’s pulp canal sealer ----Al – Awadhi et al IEJ: 2004

n n Good antibacterial activity Cobankara et al IEJ: 2004 is available in n Automix syringe n doublel-barrel syringe n 12 flexible tips

EXPERIMENTAL SEALERS 1. Bis GMA Unfilled Resin was tested by a group at Tufts University as a sealer. is Biocompatible but impossible to remove. Oral Surgery: 1992: 73: 490. 2. Pit & Fissure Sealants (low viscosity resin) have also been tried as root canal filling materials. Removal of smear layer is a must. Poor sealing ability.

3. Isopropyl Cyanoacrylate has been found adequate in sealing canals ………. . JOE: 1984: 10: 304. 4. Polyamide Varnish, Barrier has also been tried as a sealer. It is less effective than ZOE. JOE: 1992: 18: 25. Dentin Bonding Agents: Reported to achieve good seal with penetration of resin into D. T when compared to any other sealers. . IEJ 1996: 29 -76 -83.

n At the University of Minnesota, the efficacy of four different dentin bonding agents used as root canal sealers was tested. . No leakage was measurable in 75% of the canals sealed with Scotchbond, in 70% of canals sealed with Restodent, in 60% of canals sealed with Dentin. Adhesit and in only 30% of canals sealed with Gluma Thus they promise to be good sealers: prevents microleakage, but Disadvs: smear layer has –removed – apical 3 rd diff. bonding agents do not polymerize in presence of moisture & hyd pero. , difficulty to place without porosities, diffi to remove in failed cases. . . JOE : 1995: 11: 176 -179

Conclusion regarding endodontic sealers. All sealers r irritants in their freshly mixed state- after setting – losses its irritating property – becomes inert. All sealers r absorable. Components of sealers will be managed by immune system in –process of absorption. DCNA 1974: 115 -124.

A minimum amt – sealer should be exposed to periapical tissues. JOE: 1982: 8: 312 -316. n Many sealers –used properly have antimicrobial activity and potential to stimulate fibroblastic, osteoblastic, cementoblastic activity. n Large amts of sealer when extruds – necrosis of bone followed by bone resorption and over a period of time material gets absorbed

n Most root canal sealers produce an initial acute inflammatory reaction in c/t followed by, production of chronic foreign body reaction – especially phagocytosis –causes adverse effect on periradicular tissue healing. . n Hard & compact sealers with low solubility gets--encapsulated –fibr c/t. n Less dense & more soluble sealers – were dispersed & absorbed more rapidly. . . ENDODONTIC TOPICS : 2005 : 12 : 52 -70.

REFERENCES 1. Ingle – Endodontics – 6 th edition. 2. Ingle – Endodontics – 5 th edition. 3. Grossman – Endodontic practice – 11 th edition. 4. Cohen – pathways of the pulp – 9 th edition. 5. Weine – Endodontic therapy – 7 th edition. 6. Nisha Garg – text book of Endodontics. 7. Text book of endodontics - Bergenholtz

8. DCNA: 1967: 723 -744. 9. DCNA: 1974: 115 -124. 10. JOE: 1982: Dow and Ingle. 11. IEJ 1998: 31: 384 -393. 12. JOE 2006: 32: 4: 284 -290. 13. IEJ 1997: 30: 297 -306. 14. IEJ 1994: 27: 47 -51. 15. JADA Dec 1981: 103 -105. 16. JOE May: 1999: 25: 5 -7

17. JOE 1982: 8: 312 -316. 18. 19. 20. 21. 22. 23. 24. 25. 26. JOE 1987: 13: 220 -223. JADA 1958: 56: 381 -386. JOE 1988: 14: 527 -530. Oral surgery 1992: 73: 490 -494 Oral surgery 1989: 68: 330 -334 JOE 1984: 10: 304 -306 JOE 1992: 18: 25 -28 JOE 1995: 11: 176 -179. IEJ 1996: 29 -76 -83.

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